Controlled release formulations of levodopa and uses thereof

ABSTRACT

The current invention provides a controlled release oral solid formulation of levodopa comprising levodopa, a decarboxylase inhibitor, and a carboxylic acid. Also provided by this invention is multiparticulate, controlled release oral solid formulations of levodopa comprising: i) a controlled release component comprising a mixture of levodopa, a decarboxylase inhibitor and a rate controlling excipient; ii) a carboxylic acid component; and iii) an immediate release component comprising a mixture of levodopa and a decarboxylase inhibitor.

Throughout this application various publications are referenced. Thedisclosures of these publications in their entireties are herebyincorporated by reference into this application in order to more fullydescribe the state of the art to which this invention pertains.

FIELD OF THE INVENTION

The present invention relates to controlled release pharmaceuticalcompositions of levodopa (LD), formulated with an acid and adecarboxylase inhibitor, to yield enhanced pharmaceuticalpharmacokinetic attributes. These formulations are useful for thetreatment of conditions such as neurological diseases associated withreduced or impaired dopamine levels.

BACKGROUND OF THE INVENTION

Combinations of levodopa (LD) and a decarboxylase inhibitor (typicallycarbidopa (CD)) to treat Parkinson's disease (PD) are known in thepharmaceutical arts and are considered by many to be the ‘gold standard’treatment for symptoms of PD. Currently, several formulations containinga combination of LD and CD are commercially available, e.g., SINEMET®,STALEV®, PARCOPA®, and ATAMET®. Nonetheless, a need remains for an oralLD formulation that provides steadier plasma concentrations of LD withminimal ‘peak-to-trough’ fluctuations during daily dosing and thatyields a longer duration-of-effect than the currently available oraldosage forms of CD/LD.

Patients suffering from PD frequently have periods in which theirmobility becomes difficult, often resulting in an inability to move.Abnormally low levels of dopamine, a neurotransmitter that affectsmobility and control of the skeletal-muscular system, is commonlybelieved to be the cause of these motor symptoms in PD patients.However, administration of dopamine is not effective to treatParkinson's disease because dopamine does not cross the blood-brainbarrier. To resolve this problem, PD patients are administered levodopa,the metabolic precursor of dopamine, but levodopa is not without itsissues either.

While levodopa crosses the blood-brain barrier and is rapidly convertedto dopamine, LD is problematic because of its rapid decarboxylation bytissues other than the brain. Thus, when LD is administered alone, largedoses are required because only a small portion is transported to thebrain unchanged. Furthermore, when levodopa is administered orally it israpidly decarboxylated to dopamine in extracerebral tissues so that onlya small portion of a given dose is transported unchanged to the centralnervous system. Carbidopa inhibits the decarboxylation of peripherallevodopa and does not cross the blood-brain barrier. Since itsdecarboxylase inhibiting activity is limited to extracerebral tissues,administration of carbidopa with levodopa has been popular to makelevodopa more available for transport to the brain.

In addition to these difficulties associated with absorption of LD, overtime patients treated with LD also exhibit symptoms of “wearing off”. PDpatients treated with LD may develop motor fluctuations characterized byend-of-dose failure, peak dose dyskinesia, and akinesia. The advancedform of motor fluctuations (also commonly referred to as the ‘on-off’phenomenon) is characterized by unpredictable swings from mobility toimmobility. Although the causes of these motor fluctuations are notcompletely understood, some patients may be attenuated by treatmentregimens that produce steady plasma levels of LD. Thus, a void remainsin the LD treatment of PD patients, as plasma concentration levelsremain difficult to control.

Currently available controlled release formulations of CD/LD are meantto allow for a continuous release of drug over a prolonged period oftime in an attempt to maintain tight LD plasma ranges. However, the useof these controlled release dosage forms are problematic in that many PDpatients wake up in the morning having little or no mobility due to thewearing off of the dose taken the day/evening before. Once the previousdose has worn off, such patients are usually unwilling, or even unable,to wait for the extended period of time required for a controlledrelease dosage form to deliver the necessary plasma levels of LD. Whilethe use of an immediate release formulation of LD can reduce this ‘waittime’, the use of an immediate release formulation of LD require morefrequent dosing and are associated with more fluctuating plasma LDconcentrations. DUODOPA®, an intraduodenal infusion therapy approvedoutside of the United States, demonstrates significantly reduced motorcomplications and reduced ‘off’ time. The cumulative experiences fromDUODOPA® and experimental infusion studies show that the maintenance ofstable plasma LD concentrations and the avoidance of low trough levelsappear to be effective in reducing ‘off’ time, increasing ‘on’ timewithout disabling dyskinesia, and reduce the severity of dyskinesia incomparison to the standard oral formulations. However, such infusiontherapies are extremely inconvenient to the patient.

The results of infusion therapies, such as DUODOPA®, strongly suggest arationale for the development of a LD treatment that provide constant,or relatively steady, LD plasma concentrations to optimize relief of PDsymptoms and to minimize ‘off’ times and dyskinesias. Indeed, a needremains for a more convenient, i.e., oral, dosage form that will improvethe administration of LD to PD patients by narrowing blood plasma rangesof LD, which in turn will result in reduced ‘off times’, prolonged ‘ontime’, and decreased time to ‘on’. The present invention fills this voidby providing a novel controlled release oral solid dosage form of LDthat is formulated with a decarboxylase inhibitor and an acid, to yieldthe desired pharmacokinetic attributes, i.e., steadier plasmaconcentrations of LD over a prolonged period of time.

SUMMARY OF THE INVENTION

The current invention provides a controlled release oral solidformulation of levodopa comprising levodopa, a decarboxylase inhibitor,and a carboxylic acid that is not levodopa nor the decarboxylaseinhibitor. Also provided by this invention is multiparticulate,controlled release oral solid formulations of levodopa comprising: i) acontrolled release component comprising a mixture of levodopa, adecarboxylase inhibitor and a rate controlling excipient; ii) acarboxylic acid component; and iii) an immediate release componentcomprising a mixture of levodopa and a decarboxylase inhibitor.

The current invention additionally claims a controlled release oralsolid formulation of levodopa providing a relative steady levodopaplasma or serum concentration profile over a prolonged period of time;this controlled release oral solid formulation of levodopa having alevodopa plasma or serum concentration profile comprising: a) a time ofadministration; b) a first concentration; and c) a second concentration,wherein, the first concentration is equal to the maximum concentrationof said profile; the second concentration is the minimum concentrationoccurring at a time later than said first concentration and earlier thanor equal to about six hours following the time of administration; andwherein the second concentration is greater than or equal to about fiftypercent of the first concentration.

Further, the invention provides methods for making and using thepharmaceutical formulations of the invention. Methods for reducing motorfluctuations in a patient suffering from Parkinson's disease, reducingoff time in a patient suffering from Parkinson's disease, increasing ontime in a patient suffering from Parkinson's disease, reducing time to‘on’ in a patient suffering from Parkinson's disease and otherwiseenhancing dopamine levels in a subject suffering from a diseaseassociated with reduced or impaired dopamine levels are provided by thepresently claimed invention.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a graph showing that IPX066 formulations provide infusion-likeplasma profile for longer than about six hours.

FIG. 2 shows a graph illustrating the in vivo plasma concentrationprofiles for IPX066-B-05-07 Formulations A, B and C compared to areference (Sinemet®), as described in Example 1, infra.

FIG. 3 shows a graph illustrating the in vivo plasma concentrationprofiles for IPX066-B-06-02 Formulations A, B, D and E compared to areference (Sinemet®), as described in Example 2, infra.

FIG. 4 shows a graph illustrating the in vivo plasma concentrationprofiles for IPX066-B-07-01 Formulations A, B and C compared to areference (Sinemet®), as described in Example 3, infra.

FIG. 5 shows a graph illustrating the in vivo plasma concentrationprofiles for IPX066 formulations.

FIG. 6 is a table showing the robust lower intrasubject variability ofthe IPX066 formulations compared to Sinemet® CR.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to controlled release pharmaceuticalformulations comprising LD, a decarboxylase inhibitor and a carboxylicacid for treating neurological diseases or conditions associated withreduced or impaired dopamine levels. The pharmaceutical formulations ofthe invention provide steadier, or more constant, LD plasmaconcentrations in patients, resulting in decreased motor-fluctuations,reduced “off” time and increased “on” time in PD patients.

DEFINITIONS

All scientific and technical terms used in this application havemeanings commonly used in the art unless otherwise specified. As used inthis application, the following words or phrases have the meaningsspecified.

The term “acid” refers to a chemical compound that, when dissolved inwater, gives a solution with a pH less than 7. The “acid” can beorganic. It can have a pKa it the range of e.g., 2-5. Examples of acidssuitable for the invention include, but are not limited to, tartaricacid, adipic acid, succinic acid, citric acid, benzoic acid, aceticacid, ascorbic acid, edetic acid, fumaric acid, lactic acid, malic acid,oleic acid, sorbic acid, stearic acid, palmitic and boric acid ormixtures thereof.

The term “effective amount” means an amount of a compound/compositionaccording to the present invention effective in producing the desiredtherapeutic effect.

A “tablet” or “pill” comprises a pharmaceutical formulation pressed intoa form. The form can be in any shape, for example, round, oblong,triangular or other shapes.

A “capsule” comprises a pharmaceutical formulation in which thepharmaceutical formulation is encased in a hard or soft solublecontainer. The container can be in the form of gelatin or othermaterial.

The term “modified release” (also known as MR) includes delayed release(also known as DR) and controlled release (also known as CR, sustainedrelease (SR), prolonged release (PR) or extended release (ER)).

The term “delayed release” (also known as DR) relates to apharmaceutical formulation or component that releases the activeingredients after a period of delay.

The term “controlled release” (also known as CR) refers to apharmaceutical formulation or component thereof that releases, ordelivers, one or more pharmaceutical agents over a prolonged period oftime, in this case over a period of more than one hour.

The term “immediate release” (also known as instant release or IR)refers to a pharmaceutical formulation or component thereof whichreleases, or delivers, one or more pharmaceutical agents substantiallyimmediately upon administration and will result in substantiallycomplete dissolution within about one hour (or less).

The terms “release excipient” or “rate controlling excipient” may beused interchangeably. Release excipients or rate controlling excipientsinclude all excipients and/or polymers that control the release of apharmaceutical agent(s), e.g., LD, CD and in this case acid, afteradministration in a subject. Examples of release excipients or ratecontrolling excipients include, but are not limited to, hypromellose,hydroxypropyl cellulose, ethyl cellulose and prop-2-enoic acid. Delayrelease polymers, as a subset of release excipients or rate controllingexcipients, are used to delay the release of a pharmaceutical agent(s)after administration to a subject. Examples of delay release polymersinclude, but are not limited to, enteric polymers and/or neutralmethacrylic polymers such as Eudragit® L100-55, Eudragit® S100 orEudragit® FS30D (Rohm).

The “USP paddle method” refers to the Paddle and Basket Method asdescribed in United States Pharmacopoeia, Edition XXII (1990).

The term “peak-to-trough ratio” refers to a comparison of the values fora peak (e.g., a high point in a line graph) plasma level of active agentand a trough (e.g., a low point in a line graph) level over a set amountof time. For example, in a line graph with plasma LD values ranging from400 ng/ml (peak) compared to 200 ng/ml (trough) over a four hour period,gives a peak-to-trough ratio of 2 for that time. More than onepeak-to-trough ratio can be illustrated in a graph.

The term “about” when used in connection with percentages means+/−1%.

The “Mean Plasma Concentration” of a substance (e.g., LD or CD) as usedherein, refers to the mean concentration of the substance found inmultiple plasma samples. The mean plasma concentration is obtained byadding the concentrations of the substance found in the plasma samplesthen dividing the sum by the number of plasma samples.

The “upper small intestine” refers to the portion closest to the stomachand includes the duodenum and jejunum.

The term “outer coat” refers to a covering or barrier applied to apharmaceutical formulation or component thereof and may be an entericcoat.

Diseases associated with reduced or impaired dopamine levels includesneurological or movement disorders such as restless leg syndrome,Alzheimer's disease, dystonia, schizophrenia, Parkinson's disease andsecondary parkinsonism, Huntington's disease,Attention-Deficit/Hyperactivity Disorder (ADHD), Shy-Drager syndrome andconditions resulting from brain injury, including carbon monoxide ormanganese intoxication.

The term “treating” a disease associated with reduced or impaireddopamine levels, means to manage a disease with the pharmaceuticalformulation of the invention. Treatment can decrease the symptoms of adisease, reduce the severity of a disease, alter the course of diseaseprogression, ameliorate and/or cure a disease associated with theneurological or movement disorders associated with reduced or impaireddopamine levels.

COMPOSITIONS OF THE INVENTION

A significant aspect of the invention relates to the unexpecteddiscovery of the effect of carboxylic acid, in controlling theabsorption of LD such that the resulting formulations yield ‘tighter,’i.e. steadier, LD plasma concentrations.

The invention provides controlled release oral solid formulations oflevodopa comprising levodopa, a decarboxylase inhibitor, and acarboxylic acid. In one embodiment of the invention, the carboxylic acidis neither levodopa nor a decarboxylase inhibitor. In accordance withthe practice of the invention, the carboxylic acid may be physicallyseparated from the levodopa and the decarboxylase inhibitor. Thepharmaceutical formulations can include a single acid or a mixture ofacids.

In one embodiment, the carboxylic acid may be a polycarboxylic acid. Inanother embodiment, the carboxylic acid may be a dicarboxylic acid.Suitable examples of carboxylic acids include, but are not limited to,tartaric acid, adipic acid, succinic acid, citric acid, benzoic acid,acetic acid, ascorbic acid, edetic acid, fumaric acid, lactic acid,malic acid, oleic acid, sorbic acid, stearic acid, palmitic acid andboric acid or mixtures thereof. In a particular embodiment, thedicarboxylic acid is a tartaric acid.

A suitable example of a decarboxylase inhibitor includes but is notlimited to carbidopa.

In accordance with the practice of the invention, the formulation may bea tablet or a caplet. The tablet or caplet may be single-layered ormulti-layered. The tablet or caplet may be a matrix tablet or caplet.

Also in accordance with the practice of the invention, the formulationmay be a multiparticulate formulation. In an embodiment of theinvention, the multiparticulates are encapsulated. In anotherembodiment, the multiparticulates are not encapsulated. Themultiparticulates may be pressed into a tablet. Alternatively, themultiparticulates may be in a sprinkle form that can be sprinkleddirectly onto food or liquids for easy ingestion.

In an embodiment of the invention, the formulation reduces intrasubjectvariability in levodopa absorption. The intrasubject variability may becalculated as the standard deviation of the levodopa concentrationdivided by the mean levodopa concentration determined over the range ofabout 0.5 hours after administration to about six hours afteradministration for a single dose of the formulation to an individualsubject which when averaged over at least 12 subjects; is less than orequal to about 0.40.

The controlled release oral solid formulation of the invention maycomprise carbidopa and levodopa in a ratio of about 1:1 to about 1:10.In one embodiment, the ratio of carbidopa to levodopa is about 1:4.

The controlled release oral solid formulation of the invention may havea ratio of moles of dicarboxylic acid to levodopa of less than 4:1. Inone embodiment, the ratio of moles of dicarboxylic acid to levodopa isgreater than 1:4 and less than 3:2. In another embodiment, the ratio ofmoles of dicarboxylic acid to levodopa is greater than 1:2 and less than4:3. In yet another embodiment, the ratio of moles of dicarboxylic acidto levodopa is greater than 2:3 and less than 5:4. In a furtherembodiment, the ratio of moles of dicarboxylic acid to levodopa isgreater than 1:1 and less than 4:3.

The controlled release oral solid formulation of the invention maycomprise from about 25 mg to about 2000 mg levodopa. In one embodiment,the formulation comprises about 50 to 600 mg of levodopa.

The controlled release oral solid formulation of the invention maycomprise from about 10 mg to about 300 mg carbidopa. In an embodiment ofthe invention, the controlled release oral solid formulation comprisesabout 10 to 80 mg of carbidopa.

The invention also provides multiparticulate, controlled release oralsolid formulations of levodopa. A multiparticulate, controlled releaseoral solid formulation of the invention comprises 1) a controlledrelease component comprising a mixture of levodopa, a decarboxylaseinhibitor and a rate controlling excipient; 2) a carboxylic acidcomponent; and 3) an immediate release component comprising a mixture oflevodopa and a decarboxylase inhibitor. In an embodiment of theinvention, the decarboxylase inhibitor is carbidopa. Themultiparticulate, controlled release oral solid formulation of theinvention may reduce intrasubject variability in levodopa absorption.

In accordance with the practice of the invention, the controlled releasecomponent may be a distinct component (e.g., separate from thecarboxylic acid and immediate release components). In an embodiment ofthe invention, the carboxylic acid component is a distinct component(e.g., separate from the controlled release and immediate releasecomponents). In yet another embodiment, the immediate release componentis a distinct component (e.g., separate from the controlled release andcarboxylic acid components). In still another embodiment of theinvention, the controlled release component, the immediate releasecomponent and the carboxylic acid component are each manufactured asdistinct, separable beads.

In an embodiment of the invention, all of the components (namely, thecontrolled release, carboxylic acid, and immediate release components)of the multiparticulate, controlled release oral solid formulation arecoformulated into a single component.

The multiparticulate, controlled release oral solid formulation of theinvention may further comprise one or more controlled release carboxylicacid components comprising a carboxylic acid and a rate controllingexcipient. Suitable examples of carboxylic acids include but are notlimited to tartaric acid, adipic acid, succinic acid, citric acid,benzoic acid, acetic acid, ascorbic acid, edetic acid, fumaric acid,lactic acid, malic acid, oleic acid, sorbic acid, stearic acid, palmiticacid and boric acid or mixtures thereof. In a particular embodiment, thecarboxylic acid is tartaric acid. Further, the controlled releasecarboxylic acid components may comprise a carboxylic acid core coatedwith one or more enteric polymers. In a particular embodiment, themultiparticulate, controlled release oral solid formulation has at leasttwo controlled release carboxylic acid components that release thecarboxylic acid at different rates.

In accordance with the practice of the invention, the rate controllingexcipient of the multiparticulate, controlled release oral solidformulation may be an enteric polymer or a mixture of more than one typeof enteric polymer. In one embodiment, the rate controlling excipient isa neutral methacrylic polymer.

In an embodiment of the multiparticulate, controlled release oral solidformulation of the invention, the controlled release component furthercomprises a carboxylic acid. The carboxylic acid may be a dicarboxylicacid.

In an embodiment of the multiparticulate, controlled release oral solidformulation of the invention, the controlled release component comprisesa core of levodopa and decarboxylase inhibitor coated with one or moreenteric polymers.

The multiparticulate, controlled release oral solid formulation providesan embodiment wherein carbidopa and levodopa is present in a ratio ofabout 1:1 to about 1:10. In one embodiment, the ratio of carbidopa tolevodopa is 1:4.

The multiparticulate, controlled release oral solid formulation of theinvention provides an embodiment wherein the ratio of moles ofcarboxylic acid to levodopa is less than 4:1. In one embodiment, themultiparticulate, controlled release oral solid formulation, has a ratioof moles of carboxylic acid to levodopa of greater than 1:4 and lessthan 3:2. In another embodiment, the multiparticulate, controlledrelease oral solid formulation has a ratio of moles of carboxylic acidto levodopa of greater than 1:2 and less than 4:3. In yet anotherembodiment, the multiparticulate, controlled release oral solidformulation has a ratio of moles of carboxylic acid to levodopa ofgreater than 2:1 and less than 4:3. In an additional embodiment, themultiparticulate, controlled release oral solid formulation has a ratioof moles of dicarboxylic acid to levodopa of greater than 1:1 and lessthan 4:3.

The multiparticulate, controlled release oral solid formulation of theinvention provides an embodiment comprising from about 25 mg to about1200 mg levodopa. In one embodiment, the multiparticulate, controlledrelease oral solid formulation comprises about 50 to about 600 mg oflevodopa.

The multiparticulate, controlled release oral solid formulation of theinvention provides an embodiment comprising from about 10 mg to about300 mg carbidopa. In an embodiment, the multiparticulate, controlledrelease oral solid formulation comprises 20 mg to about 80 mg ofcarbidopa.

The pharmaceutical formulations of the invention can further compriseexcipients including, but not limited to, surfactants (ionic andnon-ionic), lipophilic vehicles, and hydrophilic vehicles.

In accordance with the practice of the invention, examples of a ratecontrolling excipient include, but are not limited to, hydroxypropylcellulose, hypromellose, ethyl cellulose, and prop-2-enoic acid. Onesuitable example of a prop-2-enoic acid is Carbopol® (Noveon or DowChemical Co.). Examples of delay release polymers include a neutralmethacrylic polymer such Eudragit® FS30D, Eudragit® S100, Eudragit®L100-55 and/or any mixture or combination thereof (Rohm). Eudragit®L100-55 is an enteric polymer which can be used in coated dosage formsto target the drug release in the upper small intestine where the pH isabove 5.5. Eudragit® S100 can be used to achieve targeted drug releasein the lower small intestine to the colon, where the pH is above 7. Themodified release components of the formulations of this invention can beformulated with any, and/or a mixture, of the above polymers, to achievethe desired LD plasma concentration profiles. The choice of the polymersthat can be used in the invention includes, but is not limited to,Eudragit®, cellulose acetate phthalate, polyvinyl acetate phthalate,hydroxypropyl methylcellulose phthalate, hydroxypropyl methylcelluloseacetate succinate LF, hydroxypropyl methylcellulose acetate succinateHF, and others.

The pharmaceutical formulations of the invention can further compriseother excipients commonly known and used by those of skill in the art,including a plasticizer agent (e.g., triethyl citrate), lubricant (suchas talc and magnesium stearate), and disintegrant (such ascroscarmellose sodium and crospovidone), or any combination thereof.

The invention provides a controlled release oral solid formulation oflevodopa having or exhibiting a levodopa plasma or serum concentrationprofile, which profile comprises a time of administration, a firstconcentration and a second concentration. The controlled release oralsolid formulation of levodopa may further comprise at least onecarboxylic acid, for example, tartaric acid.

In accordance with the practice of the invention the first concentrationmay be equal to the maximum levodopa plasma or serum concentration ofthe profile, the second concentration may be the minimum concentrationoccurring at a time later than said first concentration and earlier thanor equal to about six hours following the time of administration. Thesecond concentration may be greater than or equal to about fifty percentof said first concentration.

In one embodiment of the formulation, the levodopa plasma or serumconcentration profile is a median levodopa plasma or serum concentrationprofile. In another embodiment, the levodopa concentration profile isthe mean levodopa plasma or serum concentration profile.

In a further embodiment, the levodopa plasma or serum concentrationprofile further comprises a third concentration. The levodopa profile inthis third concentration may be greater than or equal to fifty percentof the first concentration. Further, the third concentration may occur atime earlier than said first concentration and within about ninetyminutes of the time of administration. In a specific embodiment,levodopa in the third concentration may be greater than or equal tosixty percent of the first concentration and the second concentrationmay be greater than or equal to sixty percent of the firstconcentration.

In accordance with the practice of the invention, the secondconcentration may be the minimum concentration occurring between onehour after said time of administration and the second time. In oneembodiment, the first concentration is between 825 and 1505 ng/mL for a380 mg dose of levodopa.

The levodopa plasma or serum concentration profile may have a ratio ofmean AUC which is measured in units of ng h/mL, to the mass of levodopain the formulation, where said mass is measured in mg, is between 11:1and 25:1. In one embodiment, the ratio is between 14:1 and 19:1.Additionally, the levodopa plasma or serum concentration profile mayhave a ratio of mean AUC which is measured in units of ng h/mL, to saidfirst concentration, where said concentration is measured in units ofng/mL, of between 9:2 and 6:1.

The levodopa plasma or serum concentration profile may have a mean AUCof between 4330 and 8000 ng h/mL for a 380 mg dose of levodopa. In oneembodiment, the mean AUC is between 5000 and 7000 ng h/mL for a 380 mgdose of levodopa.

The levodopa plasma or serum concentration profile may have a ratio ofthe first concentration which is measured in units of ng/mL, to the massof levodopa in the formulation, where said mass is measured in mg, ofbetween 3:1 and 5:1. In one embodiment, the ratio is between 5:2 and7:2. In another embodiment, the ratio is greater than or equal to about3:1.

In one embodiment, the levodopa plasma or serum concentration profilecomprises a time of administration, a first concentration at a firsttime that occurs within one hour of the time of administration; a secondconcentration at a second time, that occurs after said first time; and athird concentration at a third time, that occurs at least four hoursafter said second time. The second concentration may be equal to themaximum concentration of levodopa in the profile; the firstconcentration may be equal to about fifty percent of the secondconcentration; said third concentration may be equal to about fiftypercent of the second concentration.

In another embodiment, the controlled release oral solid formulation hasa levodopa plasma or serum concentration profile substantially the sameas levodopa formulation IPX066 in FIG. 1 for a 380 mg dose of levodopa,or having a levodopa plasma or serum concentration profile substantiallyproportional to said formulation in FIG. 1 for a dose other than 380 mg.

In yet another embodiment, the controlled release oral solid formulationhas a levodopa plasma or serum concentration profile such that the ratioof the maximum concentration of the profile to the concentration at anytime between one hour and seven hours after administration of theformulation is less than or equal to 4:1.

In a further embodiment, the controlled release oral solid formulationof levodopa has a median levodopa plasma or serum concentration profilecomprising: a first concentration at a first time; a secondconcentration at a second time, that occurs within about one hour aftersaid first time; a third concentration at a third time, that occurs atleast four hours after said second time; and a maximum concentration.The second concentration may be equal to the maximum concentration ofsaid profile; the first concentration is equal to fifty percent of saidsecond concentration; the third concentration is equal to fifty percentof the second concentration.

Coating of the Pharmaceutical Formulation

Another aspect of the invention relates to the method of preparation ofthe enteric coating of the formulations containing an acid, e.g.,tartaric acid. The acid causes a slow and variable drug release rate.The prolonged and slow drug release rate may be due to the interferenceof the dissolution of the enteric coat, affected by the presence of theacid in the core. The interference can be significantly reduced bypartially neutralizing the enteric polymers of the coating, for example,by adding a base (e.g., NH₃ or NH₄OH) to the coating formulation so asto increase the pH of the coating. The neutralizing technique can beequally effective for different enteric polymers including, but notlimited to, Eudragit® L100, S100, and FS100.

METHODS OF THE INVENTION

The invention provides a method of enhancing dopamine levels in asubject suffering from a condition associated with reduced or impaireddopamine levels comprising administering to a subject an effectiveamount of a pharmaceutical formulation of the invention therebyenhancing dopamine levels in the subject suffering from a conditionassociated with reduced or impaired dopamine levels.

The invention also provides methods for enhancing or maintainingdopamine levels in a subject suffering from a condition associated withreduced or impaired dopamine levels comprising administering to thesubject an effective amount of a pharmaceutical formulation of theinvention thereby maintaining dopamine levels in the subject sufferingfrom a condition associated with reduced or impaired dopamine levels.

Enhancing or maintaining dopamine levels in a subject can treat thesubject suffering from a condition associated with reduced or impaireddopamine levels. Examples of a condition associated with reduced orimpaired dopamine levels include, but is not limited to, Alzheimer'sdisease, dystonia, schizophrenia, and Parkinson's disease.

The invention further provides methods of reducing motor fluctuations ina patient suffering from Parkinson's disease comprising administering tothe patient an effective amount of any of the formulations of theinvention thereby providing a plasma concentration of levodopa effectiveto reduce motor fluctuations in the patient. In one embodiment of theinvention, the formulation is administered in six-hour intervals.

Additionally provided are methods of reducing off time in a patientsuffering from Parkinson's disease comprising administering to thepatient an effective amount of any of the formulations of the inventionthereby providing a plasma or serum concentration of levodopa effectiveto reduce off time in the patient.

Further, the invention provides methods of increasing “on” time in apatient suffering from Parkinson's disease comprising administering tothe patient an effective amount of any of the formulations of theinvention thereby providing a plasma or serum concentration of levodopaeffective to increase on time in the patient.

Also provided are methods of reducing time to ‘on’ (e.g., acceleratingthe efficacy of levodopa) in a patient suffering from Parkinson'sdisease comprising administering to the patient an effective amount ofany of the formulations of the invention thereby providing a plasma orserum concentration of levodopa effective to reduce the time to on inthe patient.

Determining “on” and “off” time can be based on measuring conventionalparameters such as the Uniform Parkinson's Disease Rating Scale (UPDRS)motor exam, walking time, and/or tapping number. For each of theseparameters, definitions of “on” may be based on change from predosemeasure, and the results analyzed in the standard manner. For example,for the tapping number measure an about 10% change from the average ofthe predose measurements, may define the time of “on”. For walking time,an about 15% change may be used.

In accordance with the practice of the invention, the plasma or serumconcentration of levodopa comprises: a controlled release oral solidformulation of levodopa having a levodopa plasma or serum concentrationprofile comprising: a time of administration; a first concentration, anda second concentration. In one embodiment of the method, said firstconcentration is equal to the maximum concentration of said profile;said second concentration is the minimum concentration occurring at atime later than said first concentration and earlier than or equal toabout six hours following the time of administration; and wherein thesecond concentration is greater than or equal to about fifty percent ofsaid first concentration. In another embodiment, the secondconcentration is the minimum concentration occurring between one hourafter said time of administration and said second time.

In the method of the invention, the concentration profile may be themedian plasma or serum concentration profile. Further, the concentrationprofile may be the mean plasma or serum concentration profile.

In one embodiment, the concentration profile further comprises a thirdconcentration, wherein said third concentration is greater than or equalto fifty percent of said first concentration and said thirdconcentration occurs at a time earlier than said first concentration andwithin about ninety minutes of said time of administration. In anotherembodiment, the third concentration is greater than or equal to sixtypercent of said first concentration and said second concentration isgreater than or equal to sixty percent of said first concentration.

In accordance with the practice of the invention, the disease includesbut is not limited to Alzheimer's disease, dystonia, schizophrenia andParkinson's disease.

The invention further provides methods of providing a therapeuticallyeffective and stable median and/or mean blood plasma level of levodopain a subject comprising administering to the subject a therapeuticallyeffective amount of any of the formulations of the invention. In oneembodiment, the blood plasma level does not fluctuate more than 40%between 0.5 hours after administration and six hours afteradministration.

ADVANTAGES OF THE INVENTION

Optimally, after administration to a patient suffering from a conditionassociated with reduced or impaired dopamine levels, a pharmaceuticalformulation of the invention releases LD into the plasma of the patientat a steady or near constant level, i.e., with a low peak-to-troughratio of LD plasma concentration, without any significant decrease orfluctuation for an extended amount of time, for example, mimickinginfusion administration; thereby reducing motor fluctuations or the“on-off” effect associated with fluctuations in plasma LD levels causedby currently available oral dosage forms of CD/LD.

The pharmaceutical formulations of the invention provide a superiorplasma LD profile to a patient than currently available oralpharmaceutical formulations. The formulations of the invention are ableto provide a significantly smaller peak-to-trough LD plasmaconcentration ratio (i.e., narrowing the blood plasma ranges of LD afterthe initial peak) with e.g., Q6 h, dosing. Additionally, someembodiments of the pharmaceutical formulations of the invention providefor improvement by increasing the plasma level of LB. The pharmaceuticalformulations of the invention also provide narrow ranges of plasma LDlevels thereby minimizing the “on-off” effect in some patients. Thesustained, steady LD plasma profile of this invention is expected toprovide a superior and consistent disease control.

The following examples are presented to illustrate the present inventionand to assist one of ordinary skill in making and using the same. Theexamples are not intended in any way to otherwise limit the scope of theinvention.

Example 1 A Tablet of Carbidopa and Levodopa with Tartaric Acid

The bioavailability/pharmacokinetic results of a tablet formulation ofthe present invention, using 50-200 mg of CD-LD with 215 mg of tartaricacid, were compared to the controlled release version of Sinemet®.

Preparation of a Tablet of CD-LD with Tartaric Acid (IPX066-B05-07)

CD, LD, and hydroxypropyl were charged into a blender and mixeduniformly. The powder mix was then charged in a high shear granulatorand granulated with purified water. Drying of the granules was doneovernight in an oven at 60±10° C. Dried granules were passed through a25 mesh screen, then charged and blended with magnesium stearate in ablender.

To prepare the tartaric acid final blend, granular tartaric acid waspassed through a 20 mesh screen. The tartaric acid, microcrystallinecellulose, and hypromellose were charged and blended in a high shearmixer and granulated with ethyl alcohol. The resultant granules weredried in fluid bed processor at 55±10° C. The dry granules were passedthrough a 25 mesh screen then charged and blended with magnesiumstearate in a blender.

The final CD/LD and tartaric acid blends were compressed into a tablet.

Resulting Effect of Tartaric Acid on the Pharmacokinetics ofCarbidopa-Levodopa 50-200 mg Formulations in Human Subjects

TABLE 1 Strength Dissolution in Product (mg) SGF IPX066 CD/LD Tabletscontaining tartaric 50-200 Release over 4 hr acid IPX066 CD/LD Tabletswithout tartaric 50-200 Release over 6 hr acid IPX066 CD/LD Tablets withtartaric acid 50-200 Release over 6 hr Sinemet ® CR Tablets^(a) 50-200Release over 3 hr ^(a)Merck & Co., Inc., expiration date August 2007

in vitro dissolution profiles of study drugs are listed below.Formulation tables for IPX066-B05-07 A, B and C are shown at the end ofthis example.

TABLE 2 Tartaric Acid Test Formulation (mg) A bi-layer 215 B ER 0 Cbi-layer 215 Drug release (%); SGF, 50 rpm, USP Apparatus II w/basketsinker Test Compound 30 60 120 180 240 360 A CDP 16 ± 1.8 30 ± 3.5 55 ±6.2 73 ± 7.8 86 ± 7.5 97 ± 3.0 LDP 16 ± 1.8 30 ± 3.6 54 ± 6.3 72 ± 7.984 ± 7.5 95 ± 3.0 B CDP 13 ± 0.6 22 ± 1.3 38 ± 2.5 52 ± 3.5 64 ± 4.3 84± 4.7 LDP 13 ± 0.7 22 ± 1.5 39 ± 2.9 53 ± 4.1 66 ± 5.0 87 ± 5.2 C CDP 12± 0.9 21 ± 2.1 39 ± 4.6 55 ± 6.3 68 ± 6.7 86 ± 5.3 LDP 12 ± 1.1 21 ± 2.339 ± 5.0 55 ± 6.7 68 ± 7.2 87 ± 5.9

Results and Discussion: FIG. 2 shows a graph illustrating the in vivoplasma concentration profiles of three formulations of CD, LD withtartaric acid (referred to herein as IPX066-B05-07 formulations A, B andC) compared to Sinemet® after oral administration.

Pharmacokinetics of IPX066 Test B and Sinemet® CR

Following administration of one IPX066 Test B tablet, multiple peaksappeared in the LD plasma profiles, with a maximum plasma concentration(C_(max)) occurring at approximately 2.5 hours post dose (FIG. 2). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 4 hours post dose. Due to extended dissolution rate,IPX066 Test B with the dissolution rate of 6 hours as opposed to theReference Sinemet® CR with the dissolution rate of 3 hours decreased by46% in Cmax and 44% in AUC of LD, and 38% of Cmax and 41% in AUC of CD.

Pharmacokinetics of IPX066 Test C and IPX066 Test B

Following administration of one IPX066 Test C tablet, multiple peaksalso appeared in the LD plasma profiles, with C_(max) occurring atapproximately 3 hours post dose (FIG. 2). In contrast, CD was slowlyabsorbed, with median C_(max) occurring at approximately 4.5 hours postdose. Even with the extended dissolution rate, IPX066 Test C with theaddition of 215 mg of tartaric acid, when compared to IPX066 Test Bwithout the addition of tartaric acid, increased by 50% in Cmax, 41% inAUC, 119% in C6h, and 65% in C8h of LD, and 32% of Cmax and 35% in AUCof CD

Pharmacokinetics of IPX066 Test C and IPX066 Test A

Following administration of one IPX066 Test A tablet, multiple peaksalso appeared in the LD plasma profiles, with C_(max) occurring atapproximately 2 hours post dose (FIG. 2). In contrast, CD was slowlyabsorbed, with median C_(max) occurring at approximately 4.5 hours postdose. In comparison with IPX066 Test A, IPX066 Test C contained the sameamount of tartaric acid and yet a slower dissolution rate by 2 hours. Asa result, the LD Cmax, LD AUC, LD C6h, LD C8h, CD Cmax, and CD AUC werereduced by approximately 20%, 14%, 26%, 4%, 22%, and 18%, respectively.

Pharmacokinetics of IPX066 Test A and Sinemet® CR

Following administration of one IPX066 Test A tablet, multiple peaksalso appeared in the LD plasma profiles, with C_(max) occurring atapproximately 2 hours post dose (FIG. 2). In contrast, CD was slowlyabsorbed, with median C_(max) occurring at approximately 4.5 hours postdose. BE assessment demonstrated that IPX066 Test A with the dissolutionrate of 4 hours and tartaric acid included in formulation isbioequivalent to the Reference Sinemet® CR with the dissolution rate of3 hours with regard to the C_(max) and AUC values for both LD and CD. Inaddition, the C6h and C8h of LD of IPX066 Test A were lower than thoseof Reference Sinemet® CR by approximately 25% and 4%, respectively.

The data herein demonstrated that decreasing dissolution rate decreasesthe exposure of LD and CD, and addition of tartaric acid increases theC_(max) and AUC of LD and CD.

IPX066-B05-07 Formulation A

Per Tablet Ingredients % (w/w) Mg Carbidopa 16.8 54.0 Levodopa 25.47200.0 Hydroxypropyl cellulose (Klucel-LF) 12.63 99.2 Tartaric Acid 27.38215.0 Microcrystalline cellulose (Avicel PH101) 21.63 169.8 Hypromellose(Methocel K100LV) 5.48 43.0 Magnesium Stearate 0.53 4.2 Total 100 785.2Note. 53.09 mg CD, USP is equivalent to 50.0 mg CD anhydride

IPX066-B05-07 Formulation B

Per Tablet Ingredients % (w/w) Mg Carbidopa 16.8 54.08 Levodopa 62.2200.00 Hydroxypropyl cellulose 20.0 64.3 Magnesium Stearate 1.0 3.2Purified water — — Total 100.0 321.5

IPX066-B05-07 Formulation C

Per Tablet Ingredients % (w/w) mg Carbidopa 6.30 54.0 Levodopa 23.34200.00 Hydroxypropyl cellulose (Klucel-LF) 19.94 170.9 Tartaric Acid25.09 215.0 Microcrystalline cellulose (Avicel PH101) 17.82 152.7Hypromellose (Methocel K100LV) 7.03 60.2 Magnesium Stearate 0.48 4.1Total 100 856.9 Note. 53.09 mg CD, USP is equivalent to 50.0 mg CDanhydride

Example 2 Preparation of IPX066-B06-02 Formulations A and B

The following steps were performed to prepare enteric coated pelletscontaining CD and LD.

CD, LD, and microcrystalline cellulose (Avicel PH-101) were charged andmixed uniformly. The powder mix was charged into a high shear granulatorand granulated with purified water. The granulated wet mass was extrudedin an extruder with 1.0 mm hole size screen. The extrudate was chargedand spheronized in a spheronizer equipped with 3 min cross-hatch disc.The CD/LD pellets were dried at 60±10° C. in fluid bed processor. TheCD/LD pellets were passed through different size screens. The pelletscollected were retained on 18 and 25 mesh screens.

The following steps were performed to prepare the enteric coatingsolution for the CD-LD pellets.

For Formulation IPX066-B06-02 A, Eudragit® S100 and Eudragit® L100 (atthe weight ratio of 2:1) and triethyl citrate were dissolved inisopropyl alcohol and acetone solution. The mixture was mixed untildissolved. Talc was dispersed into the polymer solution and mixedcontinuously throughout the coating process.

For Formulation IPX066-B06-02 B, Eudragit® S100 and triethyl citratewere dissolved in isopropyl alcohol and acetone solution. The mixturewas mixed until dissolved. Talc was dispersed into the polymer solutionand mixed continuously throughout the coating process.

For both formulations, the CD/LD pellets were spray-coated using thecoating dispersion prepared in Glatt GPCG-1 coater. The coated pelletswere dried. The dried, coated CD/LD pellets were screened through a 16mesh screen. The screened CD/LD pellets were charged and blended withtalc in a blender.

The following steps were performed to prepare enteric coated pelletscontaining tartaric acid (TA).

TA was passed through a 20 mesh screen. The screened TA andmicrocrystalline cellulose (Avicel PH101) were charged in a high shearmixer and granulated with purified water. The granules were extruded inan extruder with 1.0 ruin hole size screen. The extrudate was chargedand spheronized into a spheronizer equipped with a 3 mm cross hatchdisc. The seeds were dried overnight in an oven at 60±10° C. The driedpellets were passed through 16, 18 and 25 mesh screens. The pelletsretained were collected on 18 and 25 mesh screens. A seal coat solutionwas prepared by charging hypromellose (Pharmacoat 606) andethylcellulose into an alcoholic solution. The mixture was mixed untildissolved. The dried TA pellets were charged in a coater and spraycoated with the seal coat solution prepared. The seal coated CD/LDpellets were dried, and passed through a 14 mesh screen.

The following steps were performed to prepare the enteric coatingsolution for the TA pellets.

For Formulation IPX066-B06-02 A, Eudragit® S100 and Eudragit® L100 (atthe weight ratio of 2:1) and triethyl citrate were dissolved inisopropyl alcohol and acetone solution. The mixture was mixed untildissolved. Talc was dispersed into the polymer solution and mixedcontinuously throughout the coating process.

For Formulation IPX066-B06-02 B, Eudragit® S100 and triethyl citratewere dissolved in isopropyl alcohol and acetone solution. The mixturewas mixed until dissolved. Talc was dispersed into the polymer solutionand mixed continuously throughout the coating process.

For both formulations, the sealed coated TA pellets were charged in aGlatt GPCG-1 coater and spray coated with the enteric coating solutionprepared. The coated TA pellets were dried. The dried, coated TA pelletswere passed through a 12 mesh screen. The coated TA pellets were chargedand blended with talc in a blender.

The following steps were performed to encapsulate the enteric coateddrug pellets and enteric coated TA pellets.

The coated CD/LD pellets prepared as described above and coated TApellets prepared as described above were encapsulated into hard gelatincapsules. The filled capsules contained 50 mg carbidopa anhydride, 200mg LD and 215 mg, TA.

Preparation of IPX066-B06-02 Formulations D and E

The following steps were performed to prepare the carbidopa (CD) andlevodopa (LD) final blend.

CD, LD, microcrystalline cellulose, and croscarmellose sodium werecharged into a blender and mixed uniformly into a powder. Corn starchwas dispersed in purified water and stirred for 15 minutes, transferredto boiling water, and stirred continuously until it became starch paste.The spray rate of the peristaltic pump was verified using the starchpaste. The powder mix prepared above was charged in a high sheargranulator and granulated with starch paste at a flow rate of 50˜1000g/min. The granules were dried in an oven at 60±10° C. until LOD waslower than 3.0%. The dried granules were passed through a 25 meshscreen. The screened CD/LD granules, crospovidone and magnesium stearatewere charged and blended in a blender.

To prepare the TA final blend, granular TA was passed through a 20 meshscreen. The TA and microcrystalline cellulose were charged and blendedin a high shear mixer and granulated with purified water. The resultinggranules were dried in an oven at 60±10° C. until L.O.D. measured by amoisture analyzer was lower than 2.0%. The dry granules were passedthrough a Fitzmill equipped with a 24 mesh screen. The dried TA granulesand magnesium stearate were charged and blended in a blender.

The final blends were compressed into core tablets as follows.

The CD/LD final blend and TA final blend were weighed, mixed andcompressed into a tablet. The tablet contained 50 mg carbidopaanhydride, 200 mg LD and 215 mg TA.

A seal coat was applied to the core tablet by spray coating the coretablet with hypromellose dissolved in the mixture of isopropyl alcoholand purified water solution in Pan Coater. The tablet were dried in thecoating pan at 60±10° C. until the L.O.D. was lower than 3.0%.

The enteric coating solution was prepared as follows.

For IPX066-B06-02 Formulation D, Eudragit® S100 and Eudragit® L100 (atthe weight ratio of 0.25:1) and triethyl citrate were dissolved inisopropyl alcohol and acetone solution. The mixture was mixed untildissolved. Talc was dispersed into the polymer solution and mixedcontinuously throughout the coating process.

For IPX066-B06-02 Formulation E, Eudragit® L100 and triethyl citratewere dissolved in isopropyl alcohol and acetone solution. The mixturewas mixed until dissolved. Talc was dispersed into the polymer solutionand mixed continuously throughout the coating process.

The sealed coated tablet was charged into a Pan Coater and spray coatedwith the enteric coating solution prepared. The coated tablet was driedin the coating pan at 40±10° C. for at least 30 minutes.

Resulting Effect of Tartaric Acid and pH of Enteric Coating on thePharmacokinetics of Carbidopa-Levodopa 50-200 mg Formulations in HumanSubjects

This study shows the effect of acid addition and of various pH ofenteric-coating to carbidopa (CD)/levodopa (LD) 50-200 mg formulation onthe PK of CD and LD.

TABLE 3 Strength Enteric Coated Product (mg) pH IPX066 CD/LD Capsulewith tartaric acid 50-200 6.5 IPX066 CD/LD Capsule with tartaric acid50-200 7.0 Sinemet ® CR Tablet^(a) 50-200 N/A IPX066 CD/LD Tablet withtartaric acid 50-200 6.5 IPX066 CD/LD Tablet with tartaric acid 50-2006.0 ^(a)Merck & Co., Inc., expiration date August 2007

Formulation information of study drugs are listed below. Formulationtables for IPX066-B06-02 A, B, D and E are shown at the end of thisexample.

TABLE 4 Particle Tartaric size Acid Test Formulation (μm) (mg) A CapsuleD(v, 0.9) = 215 36.22 D(v, 0.9) = 139.48 B Capsule D(v, 0.9) = 215 36.22D(v, 0.9) = 139.48 D Tablet D(v, 0.9) = 215 36.22 D(v, 0.9) = 139.48 ETablet D(v, 0.9) = 215 36.22 D(v, 0.9) = 139.48

Results and Discussion: FIG. 3 show a graph illustrating the in vivoplasma concentration profiles of four formulations of CD, LD and TA(referred to herein as IPX066-B06-02 formulations A, B, D and E)compared to Sinemet® after oral administration.

Pharmacokinetics of IPX066 Test A and Sinemet® CR

Following administration of one IPX066 Test A capsule, one peak appearedin the LD median plasma profiles, with a maximum plasma concentration(C_(max)) occurring at approximately 5.0 hours post dose (FIG. 3). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 6.0 hours post dose. Due to delayed dissolution rate(enteric coated pH=6.5), no LD concentration was observed before 1 hrfor IPX066 Test A and the LD concentration of IPX066 Test A between 5and 8 hr was higher than that of the Reference Sinemet® CR based on themedian profile suggesting that addition of TA (215 mg) increase theabsorption of LD in the later part of intestine. The AUC of LD forIPX066 Test A was only 58% of that of reference Sinemet® CR.

Pharmacokinetics of IPX066 Test B and Sinemet® CR

Following administration of one IPX066 Test B capsule, one peak alsoappeared in the LD median plasma profiles, with delayed and lowerC_(max) occurring at approximately 4.0 hours post dose (FIG. 3). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 4.75 hours post dose. No LD concentration was observedbefore 2 hr for IPX066 Test B. Even with the addition of TA (215 mg),IPX066 Test B did not have higher LD concentration between 5 and 8 hrwhen compared to Sinemet® CR. This could be due to the dissolution rateof TA is slower than that of LD. The AUC of LD for IPX066 Test B wasonly 23% of that of reference Sinemet® CR.

Pharmacokinetics of IPX066 Test D and Sinemet® CR

Following administration of one IPX066 Test D tablet, one peak alsoappeared in the LD median plasma profiles, with delayed and lowerC_(max) occurring at approximately 4.25 hours post dose (FIG. 3). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 6.0 hours post dose. No LD concentration was observedbefore 2 hr for IPX066 Test D. Even with the addition of TA (215 mg), LDAUC of IPX066 Test D was only 24% of that of Reference Sinemet® CR andLD concentration between 5 and 8 hr was lower than that of Sinemet® CR.This is due to the highly variable in vitro dissolution profile and thefaster release rate of TA when compared with that of LD.

Pharmacokinetics of IPX066 Test E and Sinemet® CR

Following administration of one IPX066 Test E tablet, one peak alsoappeared in the LD median plasma profiles, with delayed and lowerC_(max) occurring at approximately 4.0 hours post dose (FIG. 3). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 5.0 hours post dose. No LD concentration was observedbefore 2 hr for IPX066 Test E. Even with the addition of tartaric acid(215 mg), LD AUC of IPX066 Test E was only 20% of that of ReferenceSinemet® CR and LD concentration between 5 and 8 hr was lower than thatof Sinemet® CR. This is also due to the highly variable in vitrodissolution profile and the faster release rate of TA when compared withthat of LD.

The data herein demonstrated that delayed dissolution rate decreases theexposure of LD and CD, and addition of TA which has similar dissolutionrate to LD and CD has higher LD concentration between 5 and 8 hr whencompared to Sinemet® CR.

IPX066-B06-02 Formulation A

Ingredients % (w/w) Amount (mg) Carbidopa 14.06 53.98 Levodopa 52.10200.0 Micro crystalline Cellulose, (Avicel PH-101) 28.36 108.85Eudragit ® L100 1.14 4.39 Eudragit ® S100 2.34 8.98 Triethyl Citrate1.00 3.82 Talc 1.00 3.83 Total 100.0 383.85 Tartaric Acid 57.6 215.0Microcrystalline Cellulose, NF 4.4 53.8 (Avicel PH-101) Ethylcellulose6.6 24.8 Hypromellose, Type 2910 1.4 5.1 Eudragit ® L100 4.6 17.2Eudragit ® S100 9.4 35.1 Triethyl Citrate 4.0 14.9 Talc 2.0 7.5 Total100.0 373.4

IPX066-B06-02 Formulation B

Ingredients % (w/w) Amount (mg) Carbidopa 12.92 53.98 Levodopa 47.88200.00 Microcrystalline cellulose (Avicel PH101) 26.06 108.85 Eudragit ®S100 8.85 36.95 Triethyl Citrate 2.53 10.55 Talc 1.76 7.37 Total 100.0417.70 Tartaric Acid 57.6 215.0 Microcrystalline cellulose (AvicelPH101) 14.4 53.8 Ethycellulose 6.6 24.8 Hypromellose, 1.4 5.1 Eudragit ®S100 14.0 52.3 Triethyl Citrate 4.0 14.9 Talc 2.0 7.5 Total 100.0 373.4

IPX066-B06-02 Formulation D

Ingredients % (w/w) mg Carbidopa 8.57 53.98 Levodopa 31.77 200.00Microcrystalline cellulose (Avicel PH101) 15.17 95.5 Corn Starch, 1.438.98 Croscarmellose Sodium 1.43 8.98 Crospovidone, 0.93 5.88 MagnesiumStearate 1.13 7.11 Tartaric Acid 34.15 215.0 Hypromellose, type 29102.93 18.42 Eudragit ® L100 1.40 8.82 Eudragit ® S100 0.35 2.20 TriethylCitrate 0.50 3.15 Talc 0.25 1.57 Total 100.0 629.59

IPX066-B06-02 Formulation E

Ingredients % (w/w) Amount (mg) Carbidopa 8.57 53.98 Levodopa 31.77200.0 Avicel PH-101 15.17 95.5 Corn Starch 1.43 8.98 CroscarmelloseSodium 1.43 8.98 Crospovidone 0.93 5.88 Magnesium Stearate 1.13 7.11Tartaric Acid 34.15 215.00 Hypromellose, Type 2910 2.93 18.42 Eudragit ®L100 1.75 11.02 Triethyl Citrate 0.5 3.15 Talc 0.25 1.57 Total 100.0629.59

Example 3 Preparation of IPX066-B07-01 Formulations A, B and C

The following steps were performed to prepare enteric coated pelletscontaining Carbidopa-Levodopa (CD-LD).

CD, LD, and microcrystalline cellulose (Avicel PH-101) were blendedtogether. The mixture was charged into a high shear granulator andgranulated with purified water. The granulated wet mass was extruded inan extruder with 1.0 mm hole size screen. The extrudate was charged andspheronized in a spheronizer equipped with 3 mm cross-hatch disc. Thespheres obtained from the spheronizer were dried at 60±10° C. in a GlattGPCG-1 coater. Drying the pellets in the Glatt GPCG-1 eliminateddiscoloration of the pellets and also reduced the amount of degradationproduct DHP. The thug-loaded pellets were screened with 16, 18 and 25mesh screens and the collected pellets retained on 18 and 25 meshscreens. The core pellets were then coated with hypromellose (Pharmacoat606) aqueous solution in a Glatt GPCG-1 coater. The coated pellets werescreened with an 18 mesh screen after they were dried in GPCG-1.

The enteric coating solution was prepared as follows. For formulationIPX066-B07-01 A, Eudragit® S100 and Eudragit® L100 were dispersedseparately at the weight ratio of 5:1 into purified water and mixeduntil a uniform dispersion. 1N NH₄OH solution was then added drop-wiseto both solutions until the pH reached 5.5. The two solutions werecombined together and mixed thoroughly. A talc suspension was preparedby dispersing Talc into triethyl citrate solution in purified water andthen stirred for 1 hour. The above mixture of L100 and S100 was thencombined with the Talc dispersion and mixed thoroughly. The dispersionwas screened through a 140 mesh screen before starting the coatingprocess. For IPX066-B07-01 formulation B, the same procedure wasfollowed for formulation A except using only Eudragit® S100 polymer. ForIPX066-B07-01 formulation C, the same procedure was followed forformulation A, except using only Eudragit® FS30D polymer.

The hypromellose coated seeds were spray coated with the enteric coatingdispersion preparation. The coated CD/LD pellets were dried in an oven.The dried CD/LD pellets were passed through a 14 mesh screen. The finalblend was prepared by blending the screened CD/LD pellets with talc.

The following steps were performed to prepare enteric coated pelletscontaining TA.

TA was passed through a 20 mesh screen. The screened TA andmicrocrystalline cellulose (Avicel PH101) was charged in a high shearmixer and granulated with purified water. The wet mass was extruded inan extruder with 1.0 mm hole size screen. The extrudate was charged andspheronized in a spheronizer equipped with a 3 mm cross hatch disc. Thepellets obtained were dried overnight in an oven at 60±10° C. The driedpellets were passed through 16, 18 and 25 mesh screens and the collectedpellets retained on 18 and 25 mesh screens. The seal coat solution wasprepared by dissolving hypromellose (Pharmacoat 606) and ethylcellulosein alcoholic solution. The seal coat solution was applied to the TApellets hi a Glatt GPCG-1 coater. The pellets were dried in a GPCG-1 andpassed through a 14 mesh screen.

The enteric coating solution was prepared as follows. For IPX066-B07-01formulation A, Eudragit® S100 and Eudragit® L100 were dispersedseparately at the weight ratio of 5:1 into purified water and mixeduntil a uniform dispersion. 1N NH₄OH solution was then added drop-wiseto both solutions until pH reached 5.5. The two solutions were combinedtogether and mixed thoroughly. A talc suspension was prepared bydispersing Talc into triethyl citrate solution in purified water andthen stirred for 1 hour. The above mixture of L100 and S100 was thencombined with the Talc dispersion and mixed thoroughly. The dispersionwas screened through a 140 mesh screen before starting the coatingprocess. For IPX066-B07-01 formulation B, the same procedure wasfollowed for formulation A, except using only Eudragit® S100 polymer.For IPX066-B07-01 formulation C, the same procedure was followed forformulation A except using only Eudragit® FS30D polymer. The screenedtartaric acid pellets were charged in a Glatt GPCG-1 coater and spraycoated with the enteric coating dispersion. The coated seeds were driedin oven. The dried, coated pellets were screened through a 14 meshscreen. The final blend was prepared by blending the screened pelletsand talc.

The coated CD/LD pellets and coated TA pellets were encapsulated intohard gelatin capsules. The filled capsules contained 50 mg carbidopaanhydride, 200 mg LD and 215 mg TA.

Resulting Effect of Tartaric Acid and pH of Enteric Coating on thePharmacokinetics of Carbidopa-Levodopa 50-200 mg Formulations in HumanSubjects Objectives:

This study tested the effect of acid addition and of various pH ofenteric-coating (Eudragit® S100/L100=5, Eudragit® S100 and Eudragit® FS30D) to carbidopa (CD)/levodopa (LD) 50-200 mg formulation on the PK ofCD and LD.

TABLE 5 Strength Enteric Coated Product (mg) Polymer 1PX066 CD/LDCapsule with tartaric acid 50-200 Eudragit ® S100/L100 = 5 IPX066 CD/LDCapsule with tartaric acid 50-200 Eudragit ® S100 1PX066 CD/LD Capsulewith tartaric acid 50-200 Eudragit ® FS 30D Sinemet ® CR Tablet^(a)50-200 N/A ^(a)Merck & Co., Inc., expiration date February 2009

Formulation information and in vitro dissolution profiles of study drugsare listed below. Formulation tables for IPX066-B07-01 A, B and C areshown in the end of this example.

TABLE 6 Particle Tartaric size Acid Test Formulation (μm) (mg) A CapsuleD(v, 0.9) = 215 36.22 D(v, 0.9) = 139.48 B Capsule D(v, 0.9) = 215 36.22 D(v, 0.9) = 139,48 C Capsule D(v, 0.9) = 215  36.22 D(v, 0.9) =139.48

Results and Discussion: FIG. 4 shows a graph illustrating the in vivaplasma concentration profiles of three formulations of CD, LD and TA(referred to as IPX066-B07-01 formulations A, B and C) compared toSinemet® after oral administration.

Pharmacokinetics of IPX066 Test A and Sinemet® CR

Following administration of one IPX066 Test A capsule, one peak appearedin the LD median plasma profiles, with a maximum plasma concentration(C_(max)) occurring at approximately 2.75 hours post dose (FIG. 4), andthe LD concentration remains at the same level from 2.0 to 3.5 hrs. Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 4.0 hours post dose. Due to delayed dissolution rate(enteric coated with Eudragit® S100/L100=5), the absorption of LD (theascending phase of plasma profile) from IPX066 Test A was slow comparedwith Sinemet® CR and the LD concentration of IPX066 Test A between 5 and10 hr was higher than that of the Reference Sinemet® CR based on themedian profile suggesting that addition of TA (215 mg) increase theabsorption of T in the lower part of intestine. The AUC of LD for IPX066Test A was only 87.72% of that of reference Sinemet® CR.

Pharmacokinetics of IPX066 Test B and Sinemet® CR

Following administration of one IPX066 Test B capsule, one peak alsoappeared in the LD median plasma profiles, with delayed and lowerC_(max) occurring at approximately 5.0 hours post dose (FIG. 4). Incontrast, CD was slowly absorbed, with median C_(max) occurring atapproximately 4.5 hours post dose. No LD concentration was observedbefore 0.75 hr for 117066 Test B. Because of tartaric acid (215 mg) inthe formulation, IPX066 Test B also has higher LD concentration between5 and 8 hr when compared to Sinemet® CR. However, the AUC of LD forIPX066 Test B was only 56.5% of that of reference Sinemet® CR.

Pharmacokinetics of IPX066 Test C and Sinemet® CR

Following administration of one IPX066 Test C tablet, only 4 subjectshave detectable LD concentration (FIG. 4). This is due to the slow invitro release profile for the CD/LD core seed.

The data herein demonstrated that delayed dissolution rate decreases theexposure of LD and CD, and addition of TA to LD and CD formulation hashigher LD concentration between 5 and 8 hr when compared to Sinemet® CR.

IPX066-B07-01 Formulation A

Ingredients % (w/w) Amount (mg) Carbidopa 11.24 53.98 Levodopa 41.65200.0 Microcrystalline cellulose (Avicel PH101) 22.67 108.85 HPMC 3.9819.10 Eudragit ® L100 1.70 8.17 Eudragit ® S100 8.51 40.85 TriethylCitrate 7.13 34.26 Talc 3.04 14.58 Ammonia Solution 0.08 0.38 Total100.0 480.17 Tartaric Acid 42.27 215.0 Microcrystalline cellulose(Avicel PH101) 10.58 53.8 Ethylcellulose 4.88 24.8 HPMC 1.00 5.1Eudragit ® L100 3.48 17.7 Eudragit ® S100 17.36 88.3 Triethyl Citrate14.57 74.1 Tale 5.70 29.0 Ammonia Solution 0.16 0.8 Total 100.0 508.6

IPX066-B07-01 Formulation B

Ingredients % (w/w) Amount (mg) Carbidopa 12.65 53.98 Levodopa 46.87200.0 Microcrystalline cellulose (Avicel PH101) 25.51 108.85Hypromellose, Type 2910 4.48 19.10 Eudragit ® S100 6.42 27.38 TriethylCitrate 3.21 13.71 Talc 0.80 3.40 Amonia Solution 0.06 0.27 Total 100.0426.69 Tartaric Acid 42.38 215.0 Microcrystalline cellulose (AvicelPH101) 10.61 53.8 Ethylcellulose 4.89 24.8 Hypromellose, Type 2910 1.015.1 Eudragit ® S100 26.01 131.95 Triethyl Citrate 13.01 65.98 Talc 1.819.16 Ammonia Solution 0.29 1.46 Total 100.0 507.25

IPX066-B07-01 Formulation C

Ingredients % (w/w) Amount (mg) Carbidopa 8.57 53.98 Levodopa 31.74200.0 Microcrystalline cellulose (Avicel PH-101) 17.28 108.85Hypromellose, Type 2910 3.03 19.10 Eudragit ® FS 30D 30.31 190.97Triethyl Citrate 0.91 5.71 Talc 8.07 50.86 Ammonia Solution 0.10 0.63Total 100.0 630.10 Tartaric Acid 38.60 215.0 Microcrystalline cellulose(Avicel PH-101) 9.66 53.8 Ethylcellulose 4.45 24.8 Hypromellose, Type2910 0.92 5.1 Eudragit ® FS 30D 35.75 199.1 Triethyl Citrate 1.08 6.0Talc 9.44 52.6 Ammonia Solution 0.11 0.6 Total 100.0 557.0

Example 4

The data herein shows the bioavailability/pharmacokinetic results of anenteric coated tablet CD/LD formulations, using 50-200 mg of CD-LD with0-430 mg of tartaric acid, compared to the controlled release version ofSinemet®.

Four formulations of IPX-066-AH1 were evaluated for PK parameters.Information of the study drugs are listed below in Table 7.

Formulation A is a capsule containing IR beads exhibiting a rapiddissolution profile.

Formulation B is a capsule containing ER CD/LD beads and ER TA beads.The ER CD/LD beads were formulated by coating the IR beads withEudragit® polymers (S100:L100 ratio of 2:1). The ER TA beads were coatedwith a sealed coat and a Eudragit® coat (S100:L100 ratio of 2:1)exhibiting a dissolution profile similar to the CD/LD beads.

Formulation C is a capsule containing ER CD/ID beads and ER TA beads.The ER CD/LD beads were formulated by coating the IR beads withEudragit® polymers (S100:L100 ratio of 5:1). The ER TA beads were coatedwith a sealed coat and a Eudragit® coat (S100:L100 ratio of 5:1)exhibiting a dissolution profile similar to the CD/LD beads.

Formulation D is similar to formulation B except that the quantity ofthe TA beads is twice the amount in formulation B.

Formulation E is the reference product, Sinemet® CR 200 mg Tablet.

TABLE 7 IPX066-AH1(A-D) CD-LD Enteric Product Strength (mg) Coated pHFormulation A IPX066 CD/LD IR Capsule 50-200 — Formulation B IPX066CD/LD Capsule with 50-200 6.5 (SL2)^(b) 215 mg tartaric acid FormulationC IPX066 CD/LD Capsule with 50-200 6.5 (SL5)^(b) 215 mg tartaric acidFormulation D IPX066 CD/LD Capsule with 50-200 6.5 (SL2)^(b) 430 mgtartaric acid Formulation E Sinemet ® CR Tablet^(a) 50-200 — (Reference)^(a)Merck & Co., Inc.; ^(b)SL2: Eudragit ® S100/L100 is 2:1; SL5:Eudragit ® S100/L100 is 5:1.

The qualitative and quantitative compositions for these formulations aresummarized below in Table 8.

TABLE 8 Qualitative and Quantitative Composition of FormulationFormulation A B C D Ingredients mg/capsule Com- Com- Com- Com- ponentponent ponent ponent I II IV II Carbidopa, USP 27 27 27 27 Levodopa, USP100 100 100 100 Microcrystalline Cellulose, NF 18.4 18.4 18.4 18.4(Avicel PH-101) Lactose Monohydrate, NF 18.4 18.4 18.4 18.4 SodiumStarch Glycolate, NF 9.2 9.2 9.2 9.2 Sodium Lauryl Sulfate, NF 9.2 9.29.2 9.2 Povidone, USP 1.84 1.85 1.85 1.85 Talc, USP 1.95 1.95 4.2 1.95Methacrylic acid copolymer, — 2.25 2.15 2.05 Type A, NF (Eudragit ®L100) — 4.55 10.75 4.55 Methacrylic acid Copolymer, Type B, NF(Eudragit ® S100) — 1.95 9.00 1.95 Triethyl Citrate, NF 1N NH₄OHsolution — — 0.1 — Purified Water, USP — — N/A* — Acetone, NF N/A* N/A*— N/A* Isopropyl Alcohol, USP N/A* N/A* — N/A* Com- Com- Com- ponentponent ponent III V III Tartaric acid, NF — 107.5 107.5 215Microcrystalline Cellulose, NF (Avicel PH-101) — 26.95 26.9 53.9Ethylcellulose, NF (Ethocel Standard-10FP Premium) — 11.2 11.3 22.4Hypromellose, USP Type2910 (Pharmacoat 606, 6 cps) — 20.35 20.25 40.7Methacrylic acid copolymer, — 9.75 6.1 19.5 Type A, NF (Eudragit ® L100)— 19.3 30.35 38.6 Methacrylic acid Copolymer, Type B, NF (Eudragit ®S100) — 8.3 25.55 16.6 Triethyl Citrate, NF Talc, USP — 5.2 10.3 10.4 1NNH₄OH — — 0.3 — Purified Water, USP — — N/A* — Acetone, NF N/A* N/A* —N/A* Isopropyl Alcohol, USP N/A* N/A* — N/A* Hard Gelatin Capsule 1 unit1 unit 1 unit 1 unit Total Capsule Fill Weight 184.97 403.3 448.4 611.85*evaporated in drying process

Manufacture of IPX066-AH1 Formulations

Four formulations of IPX066-AH1

Manufacture of Component I—CD-LD Fast Release Beads

Carbidopa, levodopa, and microcrystalline cellulose, LactoseMonohydrate, Sodium Starch Glycolate, Sodium Lauryl Sulfate, andPovidone were blended and charged in a high shear granulator andgranulated with purified water. The granulated wet mass was extruded inan extruder with 1.0 mm hole size screen. The extrudate was charged andspheronized in a spheronizer equipped with 3 mm cross-hatch disc. Thespheres obtained from the spheronizer were dried in and the drug-loadedpellets were screened with 16, 18 and 25 mesh screens. The pelletsretained on 18 and 25 mesh screens were collected. The final blend wasprepared by blending the screened CD/LD pellets with talc.

Manufacture of Component II—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (2:1)

CD/LD core seeds (also referred to as pellets) were prepared asComponent I seeds except that there was no final blend with Talc. Theenteric coating solution was prepared by dissolving Eudragit® S100 andEudragit® L100 at the weight ratio of 2:1 and triethyl citrate inisopropyl alcohol and acetone solution. Talc was then dispersed into thepolymer solution and mixed continuously throughout the coating process.The CD/LD pellets were spray coated using the coating dispersion in acoater. The coated pellets were dried and then screened through a 16mesh screen. The final blend was prepared by blending the screened CD/LDpellets with talc.

Manufacture of Component III—Tartaric Acid Fast Release Beads Coatedwith Eudragit® S100:L100 (2:1)

Tartaric acid was passed through a 20 mesh screen. Screened tartaricacid and microcrystalline cellulose was charged in a high shear mixerand granulated with purified water. The wet mass was extruded in anextruder with 1.0 mm hole size screen. The extrudate was charged andspheronized in a spheronizer equipped with a 3 mm cross hatch disc andthe resulting pellets dried overnight in an oven at 60±10° C. The driedpellets were passed through 16, 18 and 25 mesh screens and the pelletsretained on 18 and 25 mesh screens were collected.

A seal coat solution was prepared by dissolving hypromellose (Pharmacoat606) and ethylcellulose in alcoholic solution. The seal coat solutionwas applied to the tartaric acid pellets in a coater. The pellets weredried and the dried pellets passed through a 14 mesh screen.

An additional seal coat was produced by dissolving hypromellose(Pharmacoat 606) in alcoholic solution. The seal coat solution wasapplied to the tartaric acid pellet coater, and then the pellets weredried in GPCG-1. The dried pellets were passed through a 14 mesh screen.

An enteric coating solution was prepared by dissolving Eudragit® S100and Eudragit® L100 at the weight ratio of 2:1 and triethyl citrate inisopropyl alcohol and acetone solution. Mix until dissolved. Talc wasdispersed into the polymer solution and mixed continuously throughoutthe coating process. The screened tartaric acid pellets were charged ina coater and spray coated with the enteric coating dispersion. Thecoated seeds were dried, and the dried, coated pellets screened througha 14 mesh screen. The final blend was prepared by blending the screenedpellets and talc.

Manufacture of Component IV—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (5:1)

Method of manufacture for this component is the same as those of thecomponent II beads, except that the preparation of the enteric coatingdispersion was changed. Specifically, the enteric coating dispersion isprepared by charging the required amount of a first portion of purifiedwater in a stainless steel container, and to which while stirring,Methacrylic Acid Copolymer, Type A, NF were charged and dispersed,thereby making a dispersion. The required amount of 1N NH₄OH solutionwas added drop wise to the dispersion.

A required amount of a second portion of purified water in a separatestainless steel container was charged. While stirring, Methacrylic AcidCopolymer, Type B, NF were charged and dispersed. Then a required amountof 1N NH₄OH solution was added drop wise to the dispersion.

A required amount of a third portion of purified water was charged in aseparate stainless steel container. Triethyl citrate was charged anddissolved and talc was added to the solution.

The first dispersion above was added and mixed to the second dispersionand to which was then added the third dispersion above. The mixedsolutions were screened through 140 mesh screen.

Manufacture of Component V—TA Fast Release Beads Coated with Eudragit®S100:L100 (5:1)

Method of manufacture for component V beads is the same as those of thecomponent III beads, except that the preparation of the enteric coatingdispersion was changed.

Specifically the enteric coating dispersion was prepared by charging therequired amount of a first portion of purified water in a stainlesssteel container and, to which, while stirring, Methacrylic AcidCopolymer, Type A, and NF were charged and dispersed to yield adispersion; then the required amount of 1N NH₄OH solution was added dropwise to the above dispersion.

In a separate stainless steel container, the required amount of thesecond portion of purified water was charged and while stirring,Methacrylic Acid Copolymer, Type B, and NF were charge and dispersed toyield a dispersion; then the required amount of 1N NH₄OH solution wasadded to the above dispersion.

In a separate stainless steel container, the required amount of thethird portion of purified water was charged and to which triethylcitrate was added and charged; then talc was added to the abovesolution.

The first dispersion above was added and mixed to the second dispersionand to which was then added the third dispersion above. The mixedsolutions were screened through 140 mesh screen.

Manufacture of the IPX066 Capsules

The required amounts of the component beads were filled into hardgelatin capsules according to the specified fill weights in the Table 9below. The in-process fill weight is controlled at target±10% of thetarget weights according to Table 9.

TABLE 9 Target Fill Weights of IPX066 Capsule Test FormulationsFormulation IPX066- IPX066- IPX066- IPX066- AH1(A) AH1(B) AH1(C) AH1(D)Components mg/capsule mg/capsule mg/capsule mg/capsule Component I Beads184.97 — — — Component II Beads — 194.75 — 194.75 Component III Beads —208.55 — 417.1  Component IV Beads — — 210.25 — Component V Beads — —238.55 — Total Capsule Fill weight 403.3  448.8  611.85

Pharmacokinetics Result for Biostudy IPX066-AH1

The Pharmacokinetics parameters of CD and LD for four testedformulations compared to Sinemet® CR after oral administration aresummarized in Table 10.

TABLE 10 Mean ratio of Ln-transformed C_(max), AUC of Levodopa andCarbidopa Parameter Test/Ref Ratio (%) LD Ln(C_(max)) A/E 192.54Ln(C_(max)) B/E 127.05 Ln(C_(max)) C/E 123.22 Ln(C_(max)) D/E 111.99Ln(AUC) A/E 126.53 Ln(AUC) B/E 115.03 Ln(AUC) C/E 127.15 Ln(AUC) D/E108.74 CD Ln(C_(max)) A/E 144.73 Ln(C_(max)) B/E 88.97 Ln(C_(max)) C/E124.35 Ln(C_(max)) D/E 81.06 Ln(AUC) A/E 161.73 Ln(AUC) B/E 91.24Ln(AUC) C/E 139.79 Ln(AUC) D/E 88.03

Results and Discussion:

The data herein demonstrated that formulation A, with the inclusion ofwater soluble filler such as lactose and a surfactant such as sodiumlauryl sulfate, exhibits a rapid LD absorption with a t_(max) of 30 min.The PK profiles of Formulation B and D are desirable. Both formulationsexhibit a significantly higher LD plasma concentration at 6 hourspost-close relative to the Sinemet® CR Tablet. The absorption of LD fromformulation B and D are also similar as indicated by a relative AUC of115% and 109%, respectively. Since the PK profiles of formulation B andD are similar, formulation D with double the quantity of TA beads doesnot offer any additional benefit over formulation B. Formulation C, withcoating consisting of Eudragit® S100:L100 ratio of 5:1, exhibits a PKprofile suggesting a faster in-vivo release relative to formulation Cand D. This is further supported by an AUC of 127% relative to Sinemet®CR Tablet indicating LD was rapidly released and absorbed in the upperGI tract.

Example 5

The data herein shows the bioavailability/pharmacokinetic results of anenteric coated tablet CD/LD formulations, using 50-300 mg of CD-LD with0-270 mg of tartaric acid compared to the controlled release version ofSinemet®. Information of study drugs are listed below in Table 11.

IPX066-AH2 Formulation A (IPX066-AH2(A)) is a capsule containing 5different component beads. Component I is an immediate-release CD/LDbead type. Component II is an ER CD/LD bead type with a fast ER releaseprofile. Component III is an ER CD/LD bead type with a slow ER releaseprofile. Component IV is a TA bead type with a release profile similarto those of Component II. Component V is a TA bead type with a releaseprofile similar to those of Component III.

IPX066-AH2 Formulation B (IPX066-AH2(B)) is a capsule containing ERCD/LD beads formulated with Cremophor RH40 and Poloxamer 188. TA is notincluded in the formulation.

IPX066-AH2 Formulation C (IPX066-AH2(C)) is a capsule containing ERCD/LD beads formulated with Cremophor RH-40 and Poloxamer 188, and TA.

IPX066-AH2 Formulation D (IPX066-AH2(D)) is a capsule containing ERCD/LD beads formulated with TA. The capsule does not contain CremophorRH40 nor Poloxamer 188.

The reference product is Sinemet® CR Tablet 200 mg.

TABLE II IPX066-AH2 CD-LD Enteric Product Strength (mg) Coated pH AIPX066 CD/LD Combo Capsule with 75-300 6.5 (SL2) for fast 270 mgtartaric acid (IR + fast release and slow release core + slow releasecore) core B IPX066 CD/LD Capsule with 50-200 6.5 (SL2) surfactants CIPX066 CD/LD/tartaric acid Capsule 50-200 6.5 (SL2) with 215 mg tartaricacid and surfactants D IPX066 CD/LD/tartaric acid Capsule 50-200 6.5(SL2) with 215 mg tartaric acid E Sinemet ® CR Tablet^(a) 50-200 —^(a)Merck & Co., Inc.

The qualitative and quantitative compositions for these formulations aresummarized below in Table 12 and Table 13.

TABLE 12 Formulation A (IPX066-AH2(A)) Formulation A Ingredientsmg/capsule Component I Carbidopa USP 6.75 Levodopa USP 25Microcrystalline Cellulose NF 4.6 Lactose Monohydrate NF 4.5 SodiumStarch Glycolate NF 2.3 Sodium Lauryl Sulfate NF 2.3 Povidone USP 0.46Talc USP 0.23 Purified Water, USP N/A* Component II Carbidopa USP 6.75Levodopa USP 25 Microcrystalline Cellulose NF 4.6 Lactose Monohydrate NF4.6 Sodium Starch Glycolate NF 2.3 Sodium Lauryl Sulfate NF 2.3 PovidoneUSP 0.46 Methacrylic acid copolymer, Type A 0.55 NF (Eudragit ® L100)Methacrylic acid Copolymer, Type B 1.15 NF (Eudragit ® S100) TriethylCitrate NF 0.48 Talc USP 0.49 Acetone, NF N/A* Isopropyl Alcohol, USPN/A* Purified Water, USP N/A* Component III Carbidopa USP 26.99 LevodopaUSP 100 Microcrystalline Cellulose NF 54.42 Methacrylic acid copolymer,Type A 2.18 NF (Eudragit ® L100) Methacrylic acid Copolymer, Type B 4.5NF (Eudragit ® S100) Triethyl Citrate NF 1.91 Talc USP 1.91 Acetone, NFN/A* Isopropyl Alcohol, USP N/A* Purified Water, USP N/A* Component IVTartaric acid NF 27 Mi crocrystalline Cellulose NF 6.79 EthylcelluloseNF 2.81 Hypromellose, Type2910 USP 5.01 Methacrylic acid copolymer, TypeA 2.44 NF (Eudragit ® L100) Methacrylic acid Copolymer, Type B 4.84 NF(Eudragit ® S100) Methyl Citrate NF 2.08 Talc USP 1.31 Acetone, NF N/A*Isopropyl Alcohol, USP N/A* Purified Water, USP N/A* Component VTartaric acid NF 107.5 Microcrystalline Cellulose NF 26.85Ethylcellulose NF 12.38 Hypromellose Type 2910 USP 2.63 Methacrylic acidcopolymer, Type A 8.62 NF (Eudragit ® L100) Methacrylic acid Copolymer,Type B 17.5 NF (Eudragit ® S100) Triethyl Citrate NF 7.45 Talc USP 4.69Acetone, NF N/A* Isopropyl Alcohol, USP N/A* Purified Water, USP N/A*Hard Gelatin Capsule 1 unit Total Capsule Fill weight 526.63 *evaporatedin drying process

TABLE 13 Formulation B, C and D (IPX066-AH2(B), IPX066-AH2(C),IPX066-AH2(D)) Formulation B C D Ingredients mg/capsule mg/capsulemg/capsule Carbidopa USP 26.99 26.99 26.99 Levodopa USP 100 100 100Microcrystalline Cellulose, NF 118.75 65.00 30.00 Lactose Monohydrate NF53.75 — — Mannitol, USP — — 50.00 Povidone, USP 17.35 — — Talc, USP23.99 11.11 9.97 Methacrylic acid 48.98 20.13 18.09 copolymer, Type A,NF (Eudragit ® L100) Methacrylic acid 98.19 40.35 36.17 Copolymer, TypeB, NF (Eudragit ® S100) Triethyl Citrate, NF 42.18 17.32 15.55 Poloxamer188, NF 33.5 33.5 — Polyoxyl 40 Hydrogenated 17.5 17.5 — Castor Oil, NF(Cremophor RH 40) Tartaric acid, NF — 107.5 107.5 Hypromellose, USP Type— 52.58 47.18 2910 Acetone, NF N/A* N/A* N/A* Isopropyl Alcohol, USPN/A* N/A* N/A* Purified Water, USP N/A* N/A* N/A* Hard Gelatin Capsule 1unit 1 unit 1 unit Total Capsule Fill Weight 581.18 491.98 441.45*evaporated in drying process

Manufacture of Formulation A (IPX066-AH2(A)) Manufacture of ComponentBead I—CD/LD Fast Release Beads

Method of manufacture for this component beads is the same as to thatfor component I beads in IPX066-AH1, as discussed in Example 4 above.

Manufacture of Component II—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture for this component beads is the same as that forcomponent II beads in IPX066-AH1, as discussed in Example 4 above.

Manufacture of Component III—CD-LD Slow Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture for this component beads is the same as that forenteric coated CD-LD beads in formulation A tested in IPX066-B06-02, asdiscussed in Example 2 above.

Manufacture of Component IV—TA Fast Release Beads Coated with Eudragit®S100:L100 (2:1)

Method of manufacture for this component beads is the same as that ofcomponent III beads in biostudy IPX066-AH1, as discussed in Example 4above.

Manufacture of Component V—TA Slow Release Beads Coated with Eudragit®S100:L100 (2:1)

Method of manufacture for this component beads is the same as that forenteric coated tartaric acid beads in formulation A tested inIPX066-B06-02 as discussed in Example 2 above.

Manufacture of the IPX066 Capsules for Formulation A

The required amounts of the component beads were filled into hardgelatin capsules according to the specified target fill weights±10%.

TABLE 14 Target Fill Weights of IPX066 Capsule Test Formulations.IPX066-AH2(A) Components mg/capsule Component I Beads 46.2 Component IIBeads 48.7 Component II Beads 191.9 Component IV Beads 52.1 Component VBeads 187.7 Total Capsule Fill weight 526.6

Manufacture of Test Formulation B (IPX066-AH2(B))

To make formulation B, a suitable amount of ethanol and purified waterwere mixed and to which Cremophor RH40 was dissolved and charged in afirst solution then povidone was charged and mixed in the solution. Aseparate granulating fluid was prepared by dissolving the requiredamount of povidone in the required amount of purified water.

Suitable amounts of carbidopa, levodopa, microcrystalline cellulose,lactose monohydrate and poloxamer were charged into a suitablegranulator and mixed until a uniform powder is formed.

The mixed powder was granulated by adding the first solution abovefollowed by continued granulation by adding the separate granulatingfluid above thereby resulting in a wet mass. The wet mass was extrudedthrough a suitable extruder equipped with a screen size of 1.0 mm. Theextrudate was spheronized in a spheronizer at an appropriate speed andthe wet extruded beads were dried in a fluidized bed dryer. The driedbeads were then passed through a US #16 mesh screen, US #18 mesh screen,US #25 mesh screen and pan. Only the beads that pass through 18 mesh butretained on 25 mesh screen are collected.

The enteric coating dispersion was prepared by dispensing and mixing asuitable amount of acetone and isopropyl alcohol and while mixing thesolution, triethyl citrate was charged and dissolved in the solution.The mixing was continued until the material was fully dissolved. Whilemixing, Methacrylic Acid Copolymer, Type A, NF was charged to thesolution. The solution was mixed until the material was fully dissolvedthen again while mixing, Methacrylic Acid Copolymer, Type B, NF wascharged to the solution. Mixing continued until the material was fullydissolved. While mixing, talc was charged and dispersed in the solution.Mixing continued throughout the coating process.

The collected beads above were charged into a suitable fluidized-bedcoater equipped with a Wurster insert and were spray coated using theenteric coating dispersion above. The coated beads were dried, and thedried beads were passed through a US #14 mesh screen. The resultingscreened material was charged and a suitable amount of talc was added toit in a suitable blender and mixed until uniform.

Manufacture of Test Formulation C (IPX066-AH2(C))

A suitable amount of ethanol and purified water was dispensed and mixedin a stainless steel container to which was charged and dissolved asuitable amount of Cremophor RH40 resulting in a granulating solution.

A suitable amount of carbidopa, levodopa, tartaric acid,microcrystalline cellulose, and poloxamer was charged into a suitablegranulator and mixed until uniform. The mixed powder was granulated withthe granulating solution above thus creating a wet mass. The wet masswas extruded through a suitable extruder equipped with a screen size of1.0 mm and the extrudate was spheronized in a suitable spheronizer at anappropriate speed.

The wet extruded beads were dried in the fluidized bed dryer. The LODwas measured using a Moisture Analyzer and the drying process wasstopped when the LOD value was not more than a target value 3%. Thedried beads were then passed through a US #16 mesh screen, US #18 meshscreen, US #25 mesh screen and pan. Only the beads retained on 18 meshand on 25 mesh screen were collected and blended.

The seal coat solution was prepared as follows. An ethanol solution wasprepared by mixing the required amount of Alcohol, USP and purifiedwater in a stainless steel container. A suitable amount hypromellose wascharged and dissolved in the ethanol solution.

The collected beads retained on 18 mesh and on 25 mesh screen werecharged into a fluidized bed coater equipped with a Wurster insert andspray coated using the seal coat solution prepared above. The coatedbeads were dried in the fluidized bed and the dried beads were passedthrough a US #14 mesh screen. The beads that pass through the screenwere collected.

The enteric coating dispersion was prepared as follows. A suitableamount of Methacrylic Acid Copolymer, Type A, NF, Methacrylic AcidCopolymer, Type B, NF, triethyl citrate and talc were dispensed. Asuitable amount of acetone and isopropyl alcohol were mixed well andduring the mixing, triethyl citrate was charged and mixed into thesolution. Methacrylic Acid Copolymer, Type A, NF was further chargedinto the solution. Mixing continued until the material was fullydissolved. Methacrylic Acid Copolymer, Type B, NF was additionallycharged into the solution. Mixing continued until the material was fullydissolved. Talc was then charged and dispersed in the solution. Mixingoccurred throughout the process.

The collected beads were coated with the enteric coating dispersion asfollows. The collected beads were charged in a suitable fluidized-bedcoater equipped with a Wurster insert and spray coated with the entericcoating dispersion above. The coated beads were then dried and the driedbeads passed through a US #14 mesh screen. The screened material wasmixed and charged with a suitable amount of talc in a blender.

Manufacture of Test Formulation D (IPX066-AH2(D))

A granulating solution was prepared by dissolving polyoxyl in a solutionof ethanol and purified water.

A suitable amount of carbidopa, levodopa, screened tartaric acid,microcrystalline cellulose, lactose monohydrate and poloxamer werecharged and mixed in a granulator. The mixed material was granulatedwith the granulating solution thereby creating a wet mass. The wet masswas extruded through a suitable extruder equipped with a screen size of1.0 mm. The resulting extrudates were spheronized in a suitablespheronizer. The wet extruded beads were dried in a fluidized bed dryerand the LOD was measuring using a Moisture Analyzer. The drying processwas stopped when the LOD value is not more than a target value 3%.

The dried beads were passed through a US #16 mesh screen, US #18 meshscreen, US #25 mesh screen and pan. Only the beads retained on 18 meshand on 25 mesh screen were collected and retained.

The dried beads were coated with a seal coat. The seal coat may beprepared as follows. An ethanol solution was prepared by mixing therequired amount of Alcohol, USP and purified water in a stainless steelcontainer to which a suitable amount hypromellose was charged. The driedbeads were charged into a fluidized bed coater equipped with a Wursterinsert and spray coated using the seal coat solution. The coated beadswere then dried in a fluidized bed and the dried coated beads passedthrough a US #14 mesh screen. The beads that passed through the screenwere collected.

The collected beads were coated with an enteric coating dispersion. Theenteric coating dispersion was prepared as follows. A suitable amount ofMethacrylic Acid Copolymer, Type A, NF, Methacrylic Acid Copolymer, TypeB, NF, triethyl citrate and talc was dispersed. A suitable amount ofacetone and isopropyl alcohol was mixed well. During the mixing,triethyl citrate was charged and dissolved in the acetone and isopropylalcohol solution. Then while mixing, Methacrylic Acid Copolymer, Type A,and NF were charged into the solution. Mixing continued until thematerial was fully dissolved. During the mixing, Methacrylic AcidCopolymer, Type B, and NF were charged into the solution. Mixingcontinued until the material was fully dissolved. Then talc was chargedand dissolved in the solution. Mixing continued throughout the coatingprocess.

The seal coated beads were charged into a suitable fluidized-bed coaterequipped with a Wurster insert and spray coated using the entericcoating dispersion. The resulting coated beads were dried and the driedbeads were passed through a US #14 mesh screen. The screened materialwere charged and mixed with a suitable amount of talc in a blender untiluniform.

Pharmacokinetics Result for Biostudy IPX066-AH2

The Pharmacokinetics parameters of CD and LD for four testedformulations compared to Sinemet® CR after oral administration aresummarized in Table 15.

TABLE 15 Mean ratio of Ln-transformed C_(max), AUC of Levodopa andCarbidopa Parameter Test/Ref Ratio (%) LD Ln(C_(max)) A/E 80.73Ln(C_(max)) B/E 16.19 Ln(C_(max)) C/E 18.15 Ln(C_(max)) D/E 16.55Ln(AUC) A/E 108.65 Ln(AUC) B/E 10.54 Ln(AUC) C/E 15.08 Ln(AUC) D/E 15.79CD Ln(C_(max)) A/E 80.12 Ln(C_(max)) B/E 7.03 Ln(C_(max)) C/E 13.85Ln(C_(max)) D/E 14.41 Ln(AUC) A/E 94.93 Ln(AUC) B/E 2.69 Ln(AUC) C/E12.54 Ln(AUC) D/E 11.06

Results and Discussion

The data herein demonstrated that formulation A achieved a desirable invivo plasma concentration profile. By combining two components oftartaric acid beads (with enteric coating on either fast or slow releasecore) with three components of CD/LD drug seeds/beads (instant releaseportion, and enteric coated portion with coating on either fast or slowrelease core), formulation A showed a significantly flatter plasmaconcentration profile with a lower C_(max) (80.7%) and comparable AUC(109%) relative to the reference drug Sinemet® CR.

A PK simulation study was conducted to calculate the peak to troughplasma concentration (PT) ratio assuming a three times daily (every 6hours) dosing regimen. The PT ratio is defined on steady state 18 hourspost-dose plasma concentration. The simulation results are summarized inTable 16, showing that formulation A has a significantly lower, 1.7, PTratio relative to Sinemet® CR, 3.4.

The addition of surfactants in formulation significantly decreased LDbioavailability. Moreover, it is more advantageous to have separate drugand tartaric acid seeds in formulation, and the incorporation oftartaric acid into same drug seeds significantly decreased LDbioavailability.

TABLE 16 Simulation of Steady State Plasma Concentration, AUC, andPeak-to-trough Concentration Ratio. CD-LD Css, Css, Peak to TroughFormulation Dose (mg) max 18 hr Plasma Conc ratio A (IPX066- 75-300 1030591 1.7 AH2(A)) E (reference) 50-200 1212 349 3.4

Example 6

Formulation with separate CD/LD containing surfactant seeds and tartaricacid seeds for IPX-066 was evaluated for PK parameters.

IPX066-AH3

Information of study drugs are listed below in Table 17. Formulation A(IPX066-AH3(A)) is a capsule containing ER CD/LD beads formulated withCremophor RH40 and Poloxamer 188 and ER TA beads with a similardissolution profile.

TABLE 17 IPX066-AH3 CD-LD Enteric Product Strength (mg) Coated pH AIPX066 CD/LD containing 50-200 6.5 (SL2) (IPX066- surfactant Capsulewith AH3(A)) 215 mg tartaric acid B Sinemet ® CR Tablet^(a) 50-200 —^(a)Merck & Co., Inc.

The qualitative and quantitative compositions for these formulations aresummarized below in Table 18.

TABLE 18 Qualitative and Quantitative Composition of Test FormulationFormulation A (IPX066-AH3(A)) Ingredients mg/capsule Bead I Carbidopa,USP 17.99 Levodopa, USP 66.67 Microcrystalline Cellulose, NF (Avicel79.17 PH-101) Lactose Monohydrate, NF 35.83 Poloxamer 188, NF (LutrolF-68, NF) 22.33 Polyoxyl 40 Hydrogenated Castor Oil, NF 11.67 (CremophorRH 40) Povidone, USP 11.57 Methacrylic acid copolymer, Type A, NF 32.65(Eudragit ® L100) Methacrylic acid Copolymer, Type B, NF 65.46(Eudragit ® S100) Triethyl Citrate, NF 28.12 Talc, USP 15.99 Acetone, NFN/A* Isopropyl Alcohol, USP N/A* Purified Water, USP N/A* Bead IITartaric acid, NF 71.67 Microcrystalline Cellulose, NF (Avicel 17.93PH-101) Ethylcellulose, NF (Ethocel Standard- 7.53 10FP Premium)Hypromellose, USP Type2910 13.50 (Pharmacoat 606, 6 cps) Methacrylicacid copolymer, Type A, NF 14.77 (Eudragit ® L100) Methacrylic acidCopolymer, Type B, NF 29.50 (Eudragit ® S100) Triethyl Citrate, NF 12.63Talc, USP 7.20 Acetone, NF N/A* Isopropyl Alcohol, USP N/A* PurifiedWater, USP N/A* Hard Gelatin Capsule 1 unit Total weight 562.18*evaporated in drying process

Manufacture of Test Formulation Manufacture of Component Bead I—CD/LDBeads

Method of manufacture for this component beads is the same as to thatfor formulation B of IPX066-AH2, as discussed above in Example 5.

Manufacture of Component Bead II—TA Beads

Method of manufacture for this component beads is the same as that ofcomponent III beads in IPX066-AH1, except the content for entericcoating is higher in formulation, as discussed in Example 4 above.

Pharmacokinetics Result for IPX066-AH3

The Pharmacokinetics parameters of CD and LD for tested formulationscompared to Sinemet® CR after oral administration are summarized inTable 19.

TABLE 19 Mean ratio of Ln-transformed C_(max), AUC of Levodopa andCarbidopa Parameter Test/Ref Ratio (%) LD Ln(C_(max)) A/B 14.89 Ln(AUC)A/B 9.88 CD Ln(C_(max)) A/B 4.87 Ln(AUC) A/B 7.11

Results and Discussion

The addition of surfactants in formulation significantly decreased LDbioavailability even when the formulation contains separate drug andtartaric acid seeds.

Example 7 Formulations for IPX066-AH4

Four formulations of IPX-066 were evaluated for PK parameters.Information of study drugs are listed below in Table 20.

TABLE 20 IPX066-AH4 Molar CD-LD Ratio of Amount of Formulation Dose (mg)TA:LD Capsule/dose A (IPX066-AH4(A)) 75-300 1.4:1 2 B (IPX066-AH4(B))90-360 1.4:1 3 C (IPX066-AH4(C)) 90-360 0.5:1 2 D (IPX066-AH4(D)) 90-3600.75:1  2 Sinemet ® CR Tablet^(a) 50-200 — — ^(a)Merck & Co., Inc.

These formulations contain CD/LD beads and LD beads with differentrelease characteristics. Similar to formulation A of IPX066-AH2, thesebeads are coated with Eudragit® L100 and S100 polymer in the ratio of1:2. The quantities of CD/LD and TA in each of the bead type are shownin Table 20.

Component I is a CD/LD bead type which exhibits an immediate-releasedissolution profile.

Component II is a CD/LD bead type which exhibits a fasterextended-release dissolution profile.

Component III is a CD/LD bead type which exhibits a slowerextended-release dissolution profile.

Component IV is a TA bead type which exhibits a dissolution profilewhich mimics those of component II.

Component V is a TA bead type which exhibits a dissolution profile whichmimics those of component III.

Component VI is a TA bead type which exhibits an intermediatedissolution profile between those of component II and III.

The qualitative and quantitative compositions for these formulations aresummarized below in Table 21.

TABLE 21 Qualitative and Quantitative Composition of FormulationFormulation A Formulation B Formulation C Formulation D (IPX066-(IPX066- (IPX066- (IPX066- AH4(A)) AH4(B)) AH4(C)) AH4(D)) Ingredientsmg/capsule mg/capsule mg/capsule mg/capsule Component I Carbidopa USP6.75 6.48 9.72 9.72 Levodopa USP 25 24 36 36 Microcrystalline CelluloseNF 4.6 4.42 6.62 6.62 Lactose Monohydrate NF 4.6 4.42 6.62 6.62 SodiumStarch Glycolate NF 2.3 2.21 3.31 3.31 Sodium Lauryl Sulfate NF 2.3 2.213.31 3.31 Povidone USP 0.46 0.44 0.66 0.66 Talc USP 0.23 0.22 0.33 0.33Purified Water, USP N/A* N/A* N/A* N/A* Component II Carbidopa USP 6.755.4 8.10 8.10 Levodopa USP 25 20 30 30 Microcrystalline Cellulose NF 4.63.68 5.52 5.52 Lactose Monohydrate NF 4.6 3.68 5.52 5.52 Sodium StarchGlycolate NF 2.3 1.84 2.76 2.76 Sodium Lauryl Sulfate NF 2.3 1.84 2.762.76 Povidone USP 0.46 0.37 0.55 0.55 Methacrylic acid copolymer, 0.560.45 0.67 0.67 Type A NF (Eudragit ® L100) Methacrylic acid Copolymer,1.14 0.91 1.36 1.36 Type B NF (Eudragit ® S100) Triethyl Citrate NF 0.490.39 0.58 0.58 Talc USP 0.49 0.39 0.58 0.58 Acetone, NF N/A* N/A* N/A*N/A* Isopropyl Alcohol, USP N/A* N/A* N/A* N/A* Purified Water, USP N/A*N/A* N/A* N/A* Component III Carbidopa USP 26.99 20.51 30.77 30.77Levodopa USP 100.00 76.00 114.00 114.00 Microcrystalline Cellulose NF54.43 41.36 62.04 62.04 Methacrylic acid copolymer, 2.19 1.67 2.50 2.50Type A NF (Eudragit ® L100) Methacrylic acid Copolymer, 4.49 3.41 5.125.12 Type B NF (Eudragit ® S100) Triethyl Citrate NF 1.91 1.45 2.18 2.18Talc USP 1.92 1.46 2.18 2.18 Acetone, NF N/A* N/A* N/A* N/A* IsopropylAlcohol, USP N/A* N/A* N/A* N/A* Purified Water, USP N/A* N/A* N/A* N/A*Component IV Tartaric acid NF 27.00 21.50 11.40 — MicrocrystallineCellulose NF 6.74 5.37 2.85 — Ethylcellulose NF 2.81 2.24 1.19 —Hypromellose, Type2910 USP 0.94 0.75 0.40 — Methacrylic acid copolymer,2.16 1.72 0.91 Type A NF (Eudragit ® L100) Methacrylic acid Copolymer,4.41 3.51 1.86 — Type B NF (Eudragit ® S100) Triethyl Citrate NF 1.871.49 0.79 — Talc USP 1.18 0.94 0.50 — Acetone, NF N/A* N/A* N/A* —Isopropyl Alcohol, USP N/A* N/A* N/A* — Purified Water, USP N/A* N/A*N/A* — Component V Tartaric acid NF 107.50 81.70 43.4 — MicrocrystallineCellulose NF 26.90 20.44 10.86 — Ethylcellulose NF 12.40 9.42 5.00 —Hypromellose Type 2910 USP 2.55 1.94 1.03 — Methacrylic acid copolymer,8.60 6.54 3.47 — Type A NF (Eudragit ® L100) Methacrylic acid Copolymer,17.55 13.34 7.09 — Type B NF (Eudragit ® S100) Triethyl Citrate NF 7.455.66 3.01 — Talc USP 4.70 3.57 1.90 — Acetone, NF N/A* N/A* N/A* —Isopropyl Alcohol, USP N/A* N/A* N/A* — Purified Water, USP N/A* N/A*N/A* — Component VI Tartaric acid NF — — — 82.20 MicrocrystallineCellulose NF — — — 20.57 Ethylcellulose NF — — — 9.14 Hypromellose Type2910 USP — — — 2.29 Methacrylic acid copolymer, 6.58 Type A NF(Eudragit ® L100) Methacrylic acid Copolymer, — — — 13.42 Type B NF(Eudragit ® S100) — Triethyl Citrate NF — — — 5.70 Talc USP — — — 3.59Acetone, NF N/A* N/A* N/A* N/A* Isopropyl Alcohol, USP N/A* N/A* N/A*N/A* Purified Water, USP N/A* N/A* N/A* N/A* Hard Gelatin Capsule 1 unit1 unit 1 unit 1 unit Total Capsule Fill weight 521.62 409.34 439.41487.25 *evaporated in drying process

Manufacture of Test Formulations Manufacture of Component I—CD-LD FastRelease Beads

Method of manufacture for this component beads is the same as to thatfor component I beads for formulation A in IPX066-AH2, as discussed inExample 5 above.

Manufacture of Component II—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture for this component beads is the same as to thatfor component II beads for formulation A in IPX066-AH2, as discussed inExample 5 above.

Manufacture of Component III—CD-LD Slow Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture for this component beads is the same as to thatfor component III beads for formulation A in IPX066-AH2, as discussed inExample 5 above.

Manufacture of Component IV—TA Fast Release Beads Coated with Eudragit®S100:L100 (2:1)

Method of manufacture for this component beads is the same as to thatfor component IV beads for formulation A in IPX066-AH2, as discussed inExample 5 above, except no additional seal coat was introduced betweenseal coating layer and enteric coating layer.

Manufacture of Component V—TA Slow Release Beads Coated with Eudragit®S100:L100 (2.1)

Method of manufacture for this component beads is the same as to thatfor component V beads for formulation A in IPX066-AH2, as discussed inExample 5 above.

Manufacture of Component VI—TA Medium Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture for this component beads is the same as to thatfor component V beads except the content ratio ofethylcellulose/hypromellose in seal coating is 4/1 instead of 5/1.

Manufacture of the IPX066 Capsules

The required amounts of the component beads were filled into hardgelatin capsules according to the specified fill weights in the Table 22below. The in-process fill weight is controlled at target±10% of thetarget weights according to Table 22.

TABLE 22 Target Fill Weights of IPX066 Capsule Test FormulationsFormulation Code IPX066-AH4(A) IPX066-AH4(B) IPX066-AH4(C) IPX066-AH4(D)Components mg/capsule mg/capsule mg/capsule mg/capsule Component I Beads46.24 44.4 66.57 66.57 Component II Beads 48.69 38.95 58.40 58.40Component III Beads 191.93 145.86 218.79 218.79 Component IV Beads 47.1137.52 19.89 — Component V Beads 187.65 142.61 75.76 — Component VI Beads— — — 143.49 Total Capsule Fill weight 521.62 409.34 439.41 487.25

Pharmacokinetics Result for IPX066-AH4

The Pharmacokinetics parameters of CD and LD for four testedformulations compared to Sinemet® CR after oral administration aresummarized in Table 23.

TABLE 23 Mean ratio of Ln-transformed C_(max), AUC of Levodopa andCarbidopa Parameter Test/Ref Ratio (%) LD Ln(C_(max)) A/E 92.29Ln(C_(max)) B/E 119.02 Ln(C_(max)) C/E 132.54 Ln(C_(max)) D/E 133.78Ln(AUC) A/E 105.14 Ln(AUC) B/E 136.15 Ln(AUC) C/E 143.73 Ln(AUC) D/E154.34 CD Ln(C_(max)) A/E 92.76 Ln(C_(max)) B/E 116.37 Ln(C_(max)) C/E126.66 Ln(C_(max)) D/E 135.66 Ln(AUC) A/E 111.12 Ln(AUC) B/E 149.98Ln(AUC) C/E 145.70 Ln(AUC) D/E 164.13

Results and Discussion

Test formulation A (IPX066-AH4(A)) showed a consistent in vivo plasmaconcentration profile as those of formulation A (IPX066-AH2(A)) inIPX066-AH2. Formulation IPX066-AH2(A) and IPX066-AH4(A) differs only inthe filler used, i.e. lactose in IPX066-AH2(A) and mannitol inIPX066-AH4(A). The relative AUC (relative to Sinemet® CR Tablet) is 109%and 105% for formulation IPX066-AH2(A) and IPX066-AH4(A), respectively.The relative C_(max) (relative to Sinemet® CR Tablet) is 80.7% and 92.3%for formulation IPX066-AH2(A) and IPX066-AH4(A), respectively.Therefore, the in-vivo performance and bioavailability of theformulation is reproducible and consistent.

Based on a simulation study, the steady state peak to trough plasmaconcentration (PT) ratio was calculated assuming a three times daily,every 6 hours, dosing. The simulated PT ratios, defined as ratio ofC_(max) and C_(SS),18 hours, are summarized in Table 24. The resultsshowed that PT ratio of formulation A (IPX066-AH4(A)), B(IPX066-AH4(B)), C (IPX066-AH4(C)), and D (IPX066-AH4(D)) are 1.8, 23,2.8, and 2.0, respectively. The PT ratio of Sinemet® CR Tablet is 3.9.Therefore, all IPX066 test formulations have a lower PT ratio relativeto the reference, Sinemet® CR Tablet.

The data herein also demonstrated the optimum molar ratio of TA:LD to be0.75, when comparing PT ratio of formulation B, C, and D.

The PK results also indicated that replacing the TA beads of fast andslow release profiles with TA beads with an intermediate release profilein formulation did not change the overall in vivo LD plasma profilesignificantly, as evidenced by the PT ratio.

TABLE 24 Simulation of Steady State Plasma Concentration, AUC, andPeak-to-trough Concentration Ratio. CD-LD TA; LD Peak to Test Dose MolarCss, Css, AUCss, Trough Plasma Formulation (mg) Ratio max 18 hr 24 Concratio A 75-300 1.4 920 511 13215 1.8 B 90-360 1.4 1238 549 17048 2.3 C90-360 0.5 1337 477 18204 2.8 D 90-360 0.75 1384 679 19848 2.0 E(reference) 50-200 0 984 254 12348 3.9

Example 8

IPX066-AH5(A) (47.5 mg CD/190 mg LD) was evaluated for PK parameters ina three way cross over PK study using Sinemet® CR (200 mg) as reference.The qualitative and quantitative compositions for this formulation aresummarized below.

TABLE 25 Quantitative Composition of Formulation IPX066-AH5(A) Dosagestrength 190 mg Ingredients % mg/capsule Carbidopa 10.21 51.29* Levodopa37.84 190.00 Tartaric acid 17.63 88.52 Microcrystalline Cellulose 19.2396.55 Mannitol 1.01 5.07 Ethylcellulose 2.03 10.2 Hypromellose, Type29100.43 2.16 Sodium Starch Glycolate 0.50 2.53 Sodium Lauryl Sulfate 0.502.53 Povidone 0.34 1.73 Talc 1.36 6.84 Methacrylic acid copolymer, TypeA 2.09 10.51 (Eudragit ® L100) Methacrylic acid Copolymer, Type B 4.2521.33 (Eudragit ® S100) Triethyl Citrate 1.82 9.16 Croscarmellose Sodium0.69 3.46 Magnesium Stearate 0.05 0.25 Purified water N/A** N/A**Isopropyl alcohol N/A** N/A** Acetone N/A** N/A** Ethyl alcohol N/A**N/A** Total 100.00 502.13 Hard Gelatin Capsules 1 unit (size 00)*Carbidopa is supplied as a monohydrate; the quantity is equivalent to47.50 mg carbidopa anhydrous accordingly. **Evaporated during dryingprocess.

Manufacture of Formulation

Four different component beads were manufactured for formulationIPX066-AH5(A). The qualitative and quantitative compositions for eachcomponent seed are summarized in Table 26.

TABLE 26 Qualitative and Quantitative Composition for 4 Component Beadsin IPX066 Capsule Test Formulation Formulation Formulation CodeIPX066-AH5(A) Ingredients mg/capsule Component I Carbidopa USP 9.45*Levodopa USP 35.00 Croscarmellose Sodium 3.46 Povidone 1.23 MagnesiumStearate 0.25 Purified Water, USP N/A** Component II Carbidopa USP 7.43*Levodopa USP 27.50 Microcrystalline Cellulose NF 5.07 Mannitol NF 5.07Sodium Starch Glycolate NF 2.53 Sodium Lauryl Sulfate NF 2.53 PovidoneUSP 0.50 Methacrylic acid copolymer, Type A 0.62 NF (Eudragit ® L100)Methacrylic acid Copolymer, Type B 1.24 NF (Eudragit ® S100) TriethylCitrate NF 0.53 Talc USP 0.54 Acetone, NF N/A** Isopropyl Alcohol, USPN/A** Purified Water, USP N/A** Component III Carbidopa USP 34.41*Levodopa USP 127.50 Microcrystalline Cellulose NF 69.39 Methacrylic acidcopolymer, Type A 2.79 NF (Eudragit ® L100) Methacrylic acid Copolymer,Type B 5.72 NF (Eudragit ® S100) Triethyl Citrate NF 2.45 Talc USP 2.44Acetone, NF N/A** Isopropyl Alcohol, USP N/A** Purified Water, USP N/A**Component IV Tartaric acid NF 88.52 Microcrystalline Cellulose NF 22.09Ethylcellulose NF 10.20 Hypromellose Type 2910 USP 2.16 Methacrylic acidcopolymer, Type A 7.10 NF (Eudragit ® L100) Methacrylic acid Copolymer,Type B 14.37 NF (Eudragit ® S100) Triethyl Citrate NF 6.18 Talc USP 3.86Acetone, NF N/A** Isopropyl Alcohol, USP N/A** Purified Water, USP N/A**Hard Gelatin Capsule 1 unit Total Capsule Fill weight 502.13 *Carbidopais supplied as a monohydrate; the quantity is equivalent to 8.75, 6.88,31.87 mg carbidopa anhydrous in component I, II, III, respectively.**evaporated in drying process

Manufacture of Component Bead I—CD/LD Ultra Fast Release Granules

The required amounts of carbidopa, levodopa, croscarmellose sodium, andpovidone were charged into a high shear granulator and mix untiluniform. The mixed powder was granulated by adding the purified water.The granules were discharged and dried in the oven at 60±10° C. The LODwas measured using a Moisture Analyzer and the drying process wasstopped when the LOD value is not more than a target value. The granuleswere crushed by using mortar and pestle. The crushed granules werepassed through a US #18 mesh screen, and collect the granules that passthrough 18 mesh screen. The collected granules were blended withmagnesium stearate.

Manufacture of Component II—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture and process flow diagram of this component beadsis the same as those of component 2 beads of formulation A in IPX066-AH4except that mannitol is replaced by lactose.

Manufacture of Component III—CD-LD Slow Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture and process flow diagram for this component beadsis the same as those of the component 3 beads of formulation A inIPX066-AH4.

Manufacture of Component IV—TA Slow Release Beads Coated with Eudragit®S100:L100 (2:1)

Method of manufacture and process flow diagram for this component beadsis the same as those of the component 5 beads of formulation A inIPX066-AH4.

Manufacture of the IPX066 Capsules for IPX066-AH5(A)

The required amounts of the component beads were filled into hardgelatin capsules according to the specified target fill weights±10%.

TABLE 27 Target Fill Weights of IPX066 Capsule Test Formulation.IPX066-AH5(A) Components mg/capsule Component I Beads 49.39 Component IIBeads 53.56 Component II Beads 244.70 Component IV Beads 154.48 TotalCapsule Fill weight 502.13

Example 9

The example describes the formulations IPX066-AH6(A), and IPX066-AH6(B)and methods for making them.

TABLE 28 Formulation IPX066- IPX066- AH6(A) AH6(B) Dosage strength 245mg 195 mg Ingredients % mg/capsule mg/capsule Carbidopa 10.21 66.14*52.64* Levodopa 37.84 245.00 195.00 Tartaric acid 17.63 132.53 105.48Microcrystalline Cellulose 19.23 124.63 99.20 Mannitol 1.01 6.43 5.12Ethylcellulose 2.03 15.27 12.15 Hypromellose, Type2910 0.43 3.23 2.57Sodium Starch Glycolate 0.50 3.21 2.55 Sodium Lauryl Sulfate 0.50 3.212.55 Povidone 0.34 2.52 2.01 Talc 1.36 9.45 7.52 Methacrylic acid 2.0914.84 11.81 copolymer, Type A (Eudragit ® L100) Methacrylic acid 4.2530.11 23.97 Copolymer, Type B (Eudragit ® S100) Triethyl Citrate 1.8212.93 10.29 Croscarmellose Sodium 0.69 5.31 4.23 Magnesium Stearate 0.050.38 0.30 Purified water N/A** N/A** N/A** Isopropyl alcohol N/A** N/A**N/A** Acetone N/A** N/A** N/A** Ethyl alcohol N/A** N/A** N/A** Total100.00 675.19 537.39 Hard Gelatin Capsules 1 unit (size 00) 1 unit (size0EL) *Carbidopa is supplied as a monohydrate; the quantity is equivalentto 61.25 mg, 48.75 mg carbidopa anhydrous accordingly. **Evaporatedduring drying process.

Manufacture of Test Formulation

Four different component beads were manufactured for test formulationIPX066-AH6(A) and AH6(B). The qualitative and quantitative compositionsfor each component seed are summarized in Table 29.

TABLE 29 Qualitative and Quantitative Composition for 4 Component Beadsin IPX066 Capsule Formulation IPX066-AH6(A) IPX066-AH6(B) Ingredientsmg/capsule mg/capsule Component I Carbidopa USP 14.50* 11.54* LevodopaUSP 53.71 42.75 Croscarmellose Sodium 5.31 4.23 Povidone 1.89 1.50Magnesium Stearate 0.38 0.30 Purified Water, USP N/A** N/A** ComponentII Carbidopa USP 9.42* 7.50* Levodopa USP 34.87 27.75 MicrocrystallineCellulose NF 6.43 5.12 Mannitol NF 6.43 5.12 Sodium Starch Glycolate NF3.21 2.55 Sodium Lauryl Sulfate NF 3.21 2.55 Povidone USP 0.63 0.51Methacrylic acid copolymer, 0.79 0.63 Type A NF (Eudragit ® L100)Methacrylic acid Copolymer, 1.57 1.25 Type B NF (Eudragit ® S100)Triethyl Citrate NF 0.67 0.53 Talc USP 0.68 0.54 Acetone, NF N/A** N/A**Isopropyl Alcohol, USP N/A** N/A** Purified Water, USP N/A** N/A**Component III Carbidopa USP 42.22* 33.60* Levodopa USP 156.42 124.50Microcrystalline Cellulose NF 85.13 67.76 Methacrylic acid copolymer,3.42 2.72 Type A NF (Eudragit ® L100) Methacrylic acid Copolymer, 7.025.59 Type B NF (Eudragit ® S100) Triethyl Citrate NF 3.01 2.39 Talc USP2.99 2.38 Acetone, NF N/A** N/A** Isopropyl Alcohol, USP N/A** N/A**Purified Water, USP N/A** N/A** Component IV Tartaric acid NF 132.53105.48 Microcrystalline Cellulose NF 33.07 26.32 Ethylcellulose NF 15.2712.15 Hypromellose Type 2910 USP 3.23 2.57 Methacrylic acid copolymer,10.63 8.46 Type A NF (Eudragit ® L100) Methacrylic acid Copolymer, 21.5217.13 Type B NF (Eudragit ® S100) Triethyl Citrate NF 9.25 7.37 Talc USP5.78 4.60 Acetone, NF N/A** N/A** Isopropyl Alcohol, USP N/A** N/A**Purified Water, USP N/A** N/A** Hard Gelatin Capsule 1 unit 1 unit TotalCapsule Fill weight 675.19 537.39 *Carbidopa is supplied as amonohydrate. **evaporated in drying process

Manufacture of Component Bead I—CD/LD Ultra Fast Release Granules

Method of manufacture and process flow diagram of this component beadsis the same as those of component 1 beads of formulation A in IPX066-AH5except that granules were dried by GPCG-1 instead of in an oven, and thegranules were milled by Fitzmill instead of crushed by motor and pestle.

Manufacture of Component II—CD-LD Fast Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture and process flow diagram of this component beadsis the same as those of component 2 beads of formulation A inIPX066-AH5.

Manufacture of Component III—CD-LD Slow Release Beads Coated withEudragit® S100:L100 (2:1)

Method of manufacture and process flow diagram for this component beadsis the same as those of the component 3 beads of formulation A inIPX066-AH5.

Manufacture of Component IV—TA Slow Release Beads Coated with Eudragit®S100:L100 (2:1)

Method of manufacture and process flow diagram for this component beadsis the same as those of the component 4 beads of formulation A inIPX066-AH5.

Manufacture of the IPX066 Capsules for IPX066-AH6(A) and (B)

The required amounts of the component beads were filled into hardgelatin capsules according to the specified target fill weights±10%.

TABLE 30 Target Fill Weights of IPX066 Capsule Test Formulation.IPX066-AH6(A) IPX066-AH6(B) Components mg/capsule mg/capsule Component IBeads 75.79 60.32 Component II Beads 67.91 54.05 Component II Beads300.21 238.94 Component IV Beads 231.28 184.08 Total Capsule Fill weight675.19 537.39

1.-76. (canceled)
 77. A method of reducing motor fluctuations in apatient suffering from a disease associated with reduced or impaireddopamine levels comprising administering to the patient an effectiveamount of a controlled release oral solid formulation of levodopathereby providing a plasma concentration of levodopa effective to reducemotor fluctuations in the patient, (i) wherein the controlled releaseoral solid formulation of levodopa comprises (a) levodopa, (b)carbidopa, and (c) a carboxylic acid that is not (a) or (b), wherein thecarboxylic acid of (c) is in a distinct bead from (a) or (b); or (ii)wherein the controlled release oral solid formulation of levodopa is amultiparticulate, controlled release oral solid formulation of levodopacomprising (a) a controlled release component comprising a mixture oflevodopa, carbidopa and a rate controlling excipient; (b) an immediaterelease component comprising a mixture of levodopa and carbidopa, and c)a carboxylic acid component, wherein the carboxylic acid component is adistinct component from the components of (a) or (b). 78.-81. (canceled)82. A method of enhancing dopamine levels in a subject suffering from adisease associated with reduced or impaired dopamine levels comprisingadministering to a subject an effective amount of a controlled releaseoral solid formulation of levodopa thereby providing a plasma or serumconcentration of levodopa effective to enhance dopamine levels in thesubject suffering from a disease associated with reduced or impaireddopamine levels, (i) wherein the controlled release oral solidformulation of levodopa comprises (a) levodopa, (b) a decarboxylaseinhibitor, and (c) a carboxylic acid that is not (a) or (b), wherein thecarboxylic acid of (c) is in a distinct bead from (a) or (b); or (ii)wherein the controlled release oral solid formulation of levodopa is amultiparticulate, controlled release oral solid formulation of levodopacomprising (a) a controlled release component comprising a mixture oflevodopa, a decarboxylase inhibitor and a rate controlling excipient;(b) an immediate release component comprising a mixture of levodopa anda decarboxylase inhibitor, and (c) a carboxylic acid component, whereinthe carboxylic acid component is a distinct component from thecomponents of (a) or (b). 83.-92. (canceled)
 93. The method of claim 82,wherein the decarboxylase inhibitor is carbidopa.
 94. The method ofclaim 77, wherein the disease associated with reduced or impaireddopamine levels is any of restless leg syndrome, Alzheimer's disease,dystonia, schizophrenia, Parkinson's disease and secondary parkinsonism,Huntington's disease, Attention-Deficit/Hyperactivity Disorder (ADHD),Shy-Drager syndrome and injury to the nervous system by carbon monoxideor manganese intoxication.
 95. The method of claim 82, wherein thedisease associated with reduced or impaired dopamine levels is any ofrestless leg syndrome, Alzheimer's disease, dystonia, schizophrenia,Parkinson's disease and secondary parkinsonism, Huntington's disease,Attention-Deficit/Hyperactivity Disorder (ADHD), Shy-Drager syndrome andinjury to the nervous system by carbon monoxide or manganeseintoxication.
 96. The method of claim 77, wherein the carboxylic acid isselected from a group consisting of tartaric acid, adipic acid, succinicacid, citric acid, benzoic acid, acetic acid, edetic acid, fumaric acid,lactic acid, malic acid, oleic acid, sorbic acid, stearic acid, palmiticacid and boric acid or mixtures thereof.
 97. The method of claim 82,wherein the carboxylic acid is selected from a group consisting oftartaric acid, adipic acid, succinic acid, citric acid, benzoic acid,acetic acid, edetic acid, fumaric acid, lactic acid, malic acid, oleicacid, sorbic acid, stearic acid, palmitic acid and boric acid ormixtures thereof.
 98. The method of claim 77, wherein the carbidopa andlevodopa are present in the formulation in a ratio of about 1:4.
 99. Themethod of claim 82, wherein the decarboxylase inhibitor and levodopa arepresent in the formulation in a ratio of about 1:4.
 100. The method ofclaim 82, wherein the decarboxylase inhibitor is carbidopa and thecarbidopa and levodopa are present in the formulation in a ratio ofabout 1:4.
 101. The method of claim 77, wherein the controlled releaseoral solid formulation has a levodopa plasma or serum concentrationprofile comprising: a. a time of administration, b. a firstconcentration, and c. a second concentration, wherein, said firstconcentration is equal to the maximum concentration of said profile;said second concentration is the minimum concentration occurring at atime later than said first concentration and earlier than or equal toabout six hours following said time of administration; and wherein saidsecond concentration is greater than or equal to about fifty percent ofsaid first concentration.
 102. The method of claim 82, wherein thecontrolled release oral solid formulation has a levodopa plasma or serumconcentration profile comprising: a. a time of administration, b. afirst concentration, and c. a second concentration, wherein, said firstconcentration is equal to the maximum concentration of said profile;said second concentration is the minimum concentration occurring at atime later than said first concentration and earlier than or equal toabout six hours following said time of administration; and wherein saidsecond concentration is greater than or equal to about fifty percent ofsaid first concentration.
 103. The method of claim 101, wherein saidconcentration profile further comprises a third concentration, whereinsaid third concentration is greater than or equal to fifty percent ofsaid first concentration and said third concentration occurs at a timeearlier than said first concentration and within about ninety minutes ofsaid time of administration.
 104. The method of claim 102, wherein saidconcentration profile further comprises a third concentration, whereinsaid third concentration is greater than or equal to fifty percent ofsaid first concentration and said third concentration occurs at a timeearlier than said first concentration and within about ninety minutes ofsaid time of administration.
 105. The method of claim 77, wherein thecontrolled release oral solid formulation has a median levodopa plasmaor serum concentration profile comprising: a. a time of administration;b. a first concentration at a first time, that occurs within one hour ofsaid time of administration; c. a second concentration at a second time,that occurs after said first time; d. a third concentration at a thirdtime, that occurs at least four hours after said second time; wherein,said second concentration is equal to the maximum concentration of saidprofile; said first concentration is equal to about fifty percent ofsaid second concentration; said third concentration is equal to aboutfifty percent of said second concentration.
 106. The method of claim 82,wherein the controlled release oral solid formulation has a medianlevodopa plasma or serum concentration profile comprising: a. a time ofadministration; b. a first concentration at a first time, that occurswithin one hour of said time of administration; c. a secondconcentration at a second time, that occurs after said first time; d. athird concentration at a third time, that occurs at least four hoursafter said second time; wherein, said second concentration is equal tothe maximum concentration of said profile; said first concentration isequal to about fifty percent of said second concentration; said thirdconcentration is equal to about fifty percent of said secondconcentration.
 107. The method of claim 77, wherein the controlledrelease oral solid formulation has a median levodopa plasma or serumconcentration profile comprising: a. a first concentration at a firsttime; b. a second concentration at a second time, that occurs withinabout one hour after said first time; c. a third concentration at athird time, that occurs at least four hours after said second time; andd. a maximum concentration, wherein, said second concentration is equalto the maximum concentration of said profile; said first concentrationis equal to fifty percent of said second concentration; said thirdconcentration is equal to fifty percent of said second concentration.108. The method of claim 82, wherein the controlled release oral solidformulation has a median levodopa plasma or serum concentration profilecomprising: a. a first concentration at a first time; b. a secondconcentration at a second time, that occurs within about one hour aftersaid first time; c. a third concentration at a third time, that occursat least four hours after said second time; and d. a maximumconcentration, wherein, said second concentration is equal to themaximum concentration of said profile; said first concentration is equalto fifty percent of said second concentration; said third concentrationis equal to fifty percent of said second concentration.
 109. The methodof claim 77, wherein in (i): A. the levodopa of (a) and carbidopa of (b)are combined in a bead or particle; B. (a) and (b) are combined in animmediate release component separately coated with a rate controllingexcipient; or C. (a) and (b) are combined in a controlled releasecomponent separately coated with a rate controlling excipient; andwherein in (ii): A. the component of (a), (b), or (c) is a bead orparticulate; or B. (c) is in a component separately coated with a ratecontrolling excipient.
 110. The method of claim 82, wherein in (i): A.the decarboxylase inhibitor is carbidopa and the levodopa of (a) and thecarbidopa of (b) are combined in a bead or particle; B. (a) and (b) arecombined in an immediate release component separately coated with a ratecontrolling excipient; or C. (a) and (b) are combined in a controlledrelease component separately coated with a rate controlling excipient;and wherein in (ii): A. the component of (a), (b), or (c) is a bead orparticle; or B. (c) is in a component separately coated with a ratecontrolling excipient.
 111. The method of claim 109, wherein the bead,particle or component is a tablet.
 112. The method of claim 110, whereinthe bead, particle or component is a tablet.
 113. The method of claim109, wherein the bead or particle has a particle size that passesthrough (a) 12, 14, or 16 mesh but is retained on 18 or 25 mesh screensor (b) 18 mesh but is retained on 25 mesh screens.
 114. The method ofclaim 110, wherein the bead or particle has a particle size that passesthrough (a) 12, 14, or 16 mesh but is retained on 18 or 25 mesh screensor (b) 18 mesh but is retained on 25 mesh screens.
 115. The method ofclaim 111, wherein the tablet passes through (a) 12, 14, or 16 mesh butis retained on 18 or 25 mesh screens or (b) 18 mesh but is retained on25 mesh screens.
 116. The method of claim 112, wherein the tablet passesthrough (a) 12, 14, or 16 mesh but is retained on 18 or 25 mesh screensor (b) 18 mesh but is retained on 25 mesh screens.
 117. The method ofclaim 111, wherein a plurality of the tablets is encapsulated.
 118. Themethod of claim 112, wherein a plurality of the tablets is encapsulated.119. The method of claim 77, wherein in (ii) the multiparticulate,controlled release oral solid formulation of levodopa is encapsulated ina capsule and the beads, particles or components therein may be removedfrom the capsule and sprinkled on food or liquid prior toadministration.
 120. The method of claim 82, wherein in (ii) themultiparticulate, controlled release oral solid formulation of levodopais encapsulated in a capsule and the beads, particles or componentstherein are sprinkled on food or liquid prior to administration.